Conceptualisation and Measurement of Resilience of Adults With Cancer: An Umbrella Review

ABSTRACT

Aims

To (1) clarify the key components of resilience of adults with cancer; (2) summarise and analyse the resilience measures used in this population; and (3) discuss future evaluation directions.

Design

An umbrella review.

Data Sources

MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Cochrane library and Epistemonikos were searched in December 2023.

Methods

The Joanna Briggs Institute (JBI) guidelines were followed for undertaking this umbrella review. Systematic and narrative reviews that defined resilience of adults with cancer and reported resilience measures, published in English, were included. The methodological quality was assessed using the JBI appraisal tool.

Results

Fourteen eligible reviews were included. Four key resilience components from various resilience conceptualisations were identified. Twenty resilience measures were used among cancer patients, with the 25‐item Connor‐Davidson Resilience Scale providing a relatively comprehensive assessment of individual resilience. Recommended future research with cancer patients includes assessing these resilience components: (1) available individual resources—key psychological factors that enhance individual resilience; (2) access to social resources—close interpersonal relationships, family cohesion and social support; (3) adaptive coping ability—problem‐solving skills, emotional management strategies and experiences in managing adversity; (4) ability to regain mental health and well‐being—the capacity to recover a relatively stable psychological state and promote positive psychological functioning.

Conclusion

The findings provide evidence for refining future resilience measurement in the adult cancer population. Examining the four key components of resilience with this population across cultures is warranted.

Impact

Understanding the key components of resilience of cancer patients can help healthcare professionals identify individuals who may need further support and facilitate early intervention or referral to psychosocial support services. The 25‐item Connor‐Davidson Resilience Scale is recommended over other tools for use in the cancer population.

Patient or Public Contribution

Patient or public involvement is not applicable in this study.

Summary.

• What does this paper contribute to the wider global clinical community?

  • ○
    Understanding the key components of resilience of cancer patients can help healthcare professionals identify individuals who may need further support and facilitate early intervention or referral to psychosocial support services.
  • ○
    The suggested evaluation approaches for each component of resilience can assist healthcare providers in identifying key factors that cancer patients may need support with.
  • ○
    The 25‐item Connor‐Davidson Resilience Scale is recommended for use in adults with cancer as it relatively comprehensively captures the features of resilience compared to other measurement tools.

1. Introduction

Individuals affected by cancer may experience physical distress from their illness and treatments over their lifespan, such as pain (Evenepoel et al. 2022), weight loss (Nicholson et al. 2020), fatigue (Al Maqbali 2021), sleep disturbance (Wu et al. 2022), appetite loss (Ehret and Jatoi 2021), changes in physical function (Grusdat et al. 2022) and nausea and vomiting (Gupta, Walton, and Kataria 2021). These adversities and patients' concerns about mortality may also result in psychological distress including fear (Su et al. 2022), anxiety (Hung et al. 2020), depression (Hung et al. 2020) and hopelessness (Obispo‐Portero et al. 2022). Research has found that a higher proportion of cancer patients were anxious (42.7%) (Naser et al. 2021), depressed (49%) (Niedzwiedz et al. 2019), fearful of cancer recurrence (64.6%) (Luo et al. 2020) and experienced mild to moderate levels of hopelessness (Madani et al. 2018; Ravindran, Shankar, and Murthy 2019). Despite the development of a number of guidelines for psychological distress management, their implementation remains inconsistent due to a range of barriers in health facilities (e.g., lack of well‐defined policies and procedures for distress management, insufficient staff training in procedures for psychological distress management, unclear reimbursement policy for psychosocial support services) (Deshields et al. 2021). Existing evidence shows that individual resilience has a positive impact on alleviating psychological distress and acts as a protective process against it (Christie, Sharpley, and Bitsika 2024; Seiler and Jenewein 2019).

2. Background

The concept of resilience originates from the Latin word ‘resilire’ (Windle 2010), which encompasses meanings such as the act of rebounding, ‘springing back’ and ‘elasticity’ (Etymology Dictionary 2000). The concept of resilience has been applied to various fields including health, biology, economics and ecology (Holling 1973; Jain et al. 2014). Research on human resilience emerged around 1970, with early studies seeking to identify the protective factors and personal traits and characteristics that contributed to individuals' adaptation in the face of adversity, characterising resilience as either invulnerability or stress resistance (Masten 2018).

In recent years, resilience as an essential concept for describing the process of how individuals positively adapt to adversity has drawn the attention of nursing researchers (Cooper, Brown, and Leslie 2021; Henshall, Davey, and Jackson 2020a; Morse et al. 2021). In the context of cancer, individuals often face various adversities associated with their illness, which may lead to psychological distress (e.g., depression, fear, anxiety). Resilience, as a positive process of adaptation where people draw on a range of protective factors and resources, can help alleviate psychological distress and promote mental health and well‐being in the face of cancer‐related adversity (Jacobson et al. 2022; Matzka et al. 2016). Tamura et al. (2021) believe that maintaining cancer patients' mental health is an important duty of nurses' work. Since resilience is associated with mental health in adults with cancer (Tamura et al. 2021), strengthening resilience of cancer patients to facilitate their psychosocial adaptation to illness also becomes a key role for nurses. This is consistent with the tenets of holistic nursing practice (Ross et al. 2017; Szanton and Gill 2010). In a review that explored the resilience of cancer patients across their illness trajectories, Molina et al. (2014) highlighted that promoting resilience of adults with cancer was an essential part of psychosocial patient care.

There is no consistent definition of individual resilience used by nurse scholars or researchers, as the concept is interpreted in various ways. Some nurse researchers have defined resilience as a complex and dynamic process to adversity, involving multiple individual and external factors that enable individuals to positively adapt, maintain their well‐being and avoid psychological distress (Cooper et al. 2020; Foster, McCloughen et al. 2019). Others defined it as the ability to cope successfully regardless of adverse situations (Henshall, Davey, and Jackson 2020b). In the context of cancer care, the conceptualisations of individual resilience still varied, ranging from a personal protective attribute (Macia et al. 2022), a process of responding to adversity (Eicher et al. 2015) or an outcome of adaptation (i.e., maintain or recover to mental health) (Schellekens, Zwanenburg, and van der Lee 2024).

Despite inconsistency in definitions of resilience, nurse researchers have attempted to measure this concept using various instruments such as the Connor‐Davidson Resilience Scale (Connor and Davidson 2003) and the Resilience Scale (Wagnild and Young 1993). Of note, since the dimensions of different measurement tools of resilience show large variability, whether these instruments reflect a similar concept, namely resilience of cancer patients, remains unknown. To date, no agreed‐upon evaluation approach has been established to assess resilience of adults with cancer. Despite a few systematic reviews having been conducted to attempt to clarify the key resilience components of people diagnosed with cancer, the findings vary (Aizpurua‐Perez and Perez‐Tejada 2020; Fasano et al. 2020; Sihvola, Kuosmanen, and Kvist 2022). An umbrella review, which has the advantage of synthesising convergent and divergent evidence from review articles (Cant, Ryan, and Kelly 2022), is needed to (1) clarify the key components of resilience of adults with cancer; (2) summarise and analyse the resilience measures used in this population; and (3) discuss future evaluation directions.

3. The Review

3.1. Aims

The aims of this umbrella review were to (1) clarify the key components of resilience of adults with cancer; (2) summarise and analyse the resilience measures used in this population; and (3) discuss future evaluation directions.

The research questions of this umbrella review were: (1) what are the key components of resilience of adults with cancer; and (2) how to evaluate resilience in adults with cancer?

3.2. Design

An umbrella review was performed to summarise existing evidence related to the definitions and measurement tools of resilience used in adults with cancer. This review methodology is designed to examine the available body of information on a given topic or question by summarising the evidence from existing reviews (Aromataris et al. 2020; Becker and Oxman 2011). It also has benefits for comparing similar and conflicting findings of research synthesis and exploring potential reasons for the results (Aromataris et al. 2015).

Guided by the evidence synthesis approach developed by the JBI. (Aromataris et al. 2020), a review protocol was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO, register number: CRD42024518091). Findings were reported following the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA).

3.3. Search Methods

A comprehensive database search was initially conducted in MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane library and Epistemonikos in December 2023 to identify relevant articles published between 2014 and 2023. The search was repeated to include any newly published articles in 2024. This publication range was selected since researchers' understanding of the concept of resilience and its use in studies has evolved over time. Including articles published in the past 10 years allows us to capture contemporary literature on resilience while keeping the number of relevant articles manageable for the research team. Keywords and subject headings related to ‘resilience’ (e.g., resilien*, psychological resilience, personal resilien*), ‘cancer’ (e.g., neoplasms, carcinoma, malignan*) and systematic, scoping and narrative review (e.g., systematic review, scoping review, integrative review, literature review) were used as search terms in the seven databases. All search terms were combined using Boolean operators. A sample search strategy is provided in Table S1. Reference lists of relevant articles were also hand‐searched to identify additional eligible records.

With evidence supporting the inclusion of a wider range of review types in umbrella reviews based on different research aims (Balante, Broek, and White 2021; Stearns et al. 2023), this article included systematic, scoping and narrative reviews that provided a definition of the psychological resilience of adults with cancer, reported measurement tools of individual resilience, were peer‐reviewed, written in English and published between 2014 and 2024. Reviews that focused on adult survivors of childhood cancer or resilience of caregivers of cancer patients, single empirical studies, conference proceedings, case studies and commentaries were excluded.

3.4. Search Outcomes

The search results from databases and reference lists were uploaded to Covidence for study selection. Following the removal of duplicate records, two researchers (D.L. and K.W.) independently screened the titles and abstracts of all studies yielded by the search. The full texts of potentially eligible articles were retrieved and assessed for eligibility by the same two researchers. Disagreements between reviewers were resolved through discussion with a third researcher (K.F.).

A total of 2206 studies were identified through database searches and an additional three records were identified through manual searching of the reference lists of relevant articles. Following the removal of duplicates, the titles and abstracts of 1847 reviews were screened based on the eligibility criteria. The full texts of 86 reviews were retrieved and reviewed against the criteria, resulting in a total of 14 review articles being included in this review (Figure 1).

FIGURE 1.

PRISMA flowchart of search strategy and selection of eligible reviews.

3.5. Quality Appraisal

The quality of included reviews was appraised using the JBI critical appraisal checklist for Systematic Reviews and Research Syntheses. This tool examines the methodological rigour of included reviews through the assessment of 11 aspects. Each aspect is assessed with ‘Yes’, ‘No’, ‘Unclear’ and ‘Not applicable’. One point was given for a ‘Yes’ response, and zero points were given for ‘No’, ‘Unclear’ and ‘Not applicable’ responses. The methodological quality of reviews was classified into three categories based on the total points: low quality (0–4), moderate quality (5–8) and high quality (9–11) (Teixeira et al. 2019). Two researchers (D.L. and K.W.) independently appraised the quality of all included reviews. Discrepancies in the results were discussed until a consensus was reached. No articles were excluded based on the outcomes of the quality appraisal.

3.6. Data Extraction and Synthesis

Guided by the JBI data extraction tool for Systematic Reviews and Research Syntheses, a data extraction table summarising the scope of the included reviews was created and agreed upon by the review team. Details extracted from reviews include aim(s), review typology, databases searched, year range of searching, number and type of studies included, settings of primary studies, characteristics of participants, definitions of resilience and measurement tools of resilience used in adults with cancer. Data were initially extracted by a researcher (D.L.) and discussed with the research team to minimise bias and errors.

Different approaches were employed to summarise and synthesise data in accordance with the aims of this review. To clarify the components of resilience of adults with cancer, an inductive thematic synthesis was conducted to identify common features of resilience from various definitions of resilience. Specifically, the definition of resilience was initially extracted from each included review into a table, which was followed by coding by two researchers (D.L. and K.W.) independently. Codes were compared and discussed between researchers to reach an agreement before being categorised into potential themes. Themes were then confirmed and named through discussion within the research team. Measurement tools of resilience extracted from included reviews were narratively summarised. The dimensions of these tools were then mapped against the resilience components identified through thematic synthesis to examine whether these instruments could comprehensively capture the features of resilience of adults with cancer. The analysis findings were presented through narrative summaries.

4. Results

4.1. Characteristics of the Included Reviews

Fourteen eligible reviews were published from 2015 to 2024, including systematic reviews (Aizpurua‐Perez and Perez‐Tejada 2020; Ang et al. 2023; Ding et al. 2024; Fasano et al. 2020; Lau et al. 2021; Ruiz Pena et al. 2021; Sihvola, Kuosmanen, and Kvist 2022; Tamura et al. 2021), integrative reviews (Eicher et al. 2015; Sihvola, Kiwanuka, and Kvist 2023), literature reviews (Greup et al. 2018; Seiler and Jenewein 2019), a scoping review (George et al. 2023) and a narrative review (Ludolph et al. 2019). The majority of reviews solely synthesised evidence from quantitative studies (Aizpurua‐Perez and Perez‐Tejada 2020; Ang et al. 2023; Ding et al. 2024; Eicher et al. 2015; Fasano et al. 2020; Ludolph et al. 2019; Sihvola, Kuosmanen, and Kvist 2022; Sihvola, Kiwanuka, and Kvist 2023; Tamura et al. 2021), whereas three reviews also summarised findings of qualitative studies (George et al. 2023; Greup et al. 2018; Lau et al. 2021).

The selected reviews included a range of 9–154 primary studies. Most studies were conducted in North America (n = 124), with 85.5% from the United States (n = 106). Ten studies were from South America, with most conducted in Brazil (n = 7). Among research performed in Asia and Europe, the majority were from China (n = 98) and Germany (n = 15), respectively. Nineteen studies were undertaken in Oceania with a large proportion from Australia (n = 16). Additionally, one review (Fasano et al. 2020) did not specify the countries of the included studies.

Participants studied in the selected reviews were diagnosed with various types of cancer. Eleven reviews reported at least two types of cancer (Ang et al. 2023; Ding et al. 2024; Eicher et al. 2015; George et al. 2023; Greup et al. 2018; Lau et al. 2021; Ludolph et al. 2019; Ruiz Pena et al. 2021; Seiler and Jenewein 2019; Sihvola, Kiwanuka, and Kvist 2023; Tamura et al. 2021). Among the multiple types of cancer, breast cancer and colorectal cancer were extensively investigated in the included reviews. Details of the included articles are presented in Table 1.

TABLE 1.

Summary of the scope of the 16 included reviews.

Author, year	Aim(s)	Review typology	Sources searched	Year range of searching	Number and types of included studies	Countries of included studies	Participants
Aizpurua‐Perez and Perez‐Tejada (2020)	To (1) identify the biopsychosocial factors related to resilience in women with breast cancer, and (2) synthesise the evidence on interventions that may significantly promote resilience	Systematic review	PubMed, PsycInfo and Web of Science, and reference lists	From database inception–03/2020	N = 39; 30 cross‐sectional, 8 intervention design, 1 longitudinal design	11 China, 4 Spain, 4 United States, 3 Poland, 2 each from: Greece, Mexico, Iran, Republic of Macedonia. 1 each from: Saudi Arabia, Puerto Rico, Switzerland, Australia, Colombia, Japan, South Korea, Netherlands, United Kingdom	Women diagnosed with breast cancer
Ang et al. (2023)	To (1) assess the impact of resilience interventions on the resilience and posttraumatic growth of cancer patients and (2) identify crucial elements and characteristics of resilience interventions	Systematicreview, meta‐analysis, and meta‐regression	CINAHL, Cochrane, Education Resources Information Center, Embase, PsycInfo, PubMed, ProQuest Dissertations and Theses Global, Scopus and Web of Science	From database inception–01/2023	N = 23 (randomised controlled trials)	6 China, 4 Iran, 2 each from: United States, Australia, Canada, Spain. 1 each from: New Zealand Portugal, South Korea, Sweden, Turkey	Adults diagnosed with mixed types of cancers
Ding et al. (2024)	To assess the effects of various interventions on resilience and determine the most effective interventions	Systematic review and network meta‐analysis	Web of Science, PubMed, Embase, Cochrane Library, CINAHL, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Chinese Biomedical Literature Database	From database inception –06/ 2023	N = 32 (randomised controlled trials)	29 China. 1 each from: United States, Spain, Italy	Adults diagnosed with mixed types of cancers
Eicher et al. (2015)	To (1) describe researchers’ perspectives on the definition of resilience, (2) summarise quantitative studies about resilience of adults with cancer, and (3) synthesis evidence to identify implications of resilience for research and practice in cancer nursing	Integrative review	PubMed, CINAHL, and PsycInfo, reference lists.	2003–2013	N = 11; 6 cross‐sectional, 4 longitudinal, 1 intervention design	4 Germany, 3 United States. 1 each from: China, Australia, South Korea, France.	Adults diagnosed with various types of cancers. The common ones were: (1) breast cancer, (2) gynaecologic cancer, (3) digestive tract cancer, (4) prostate cancer, (5) lung cancer, (6) head and neck cancer, (7) cervical cancer, (8) others
Fasano et al. (2020)	To examine whether optimism, coping, and resilience are independent predictors of anxiety, depression, distress, and health‐related quality of life in women with breast cancer	Systematic review and meta‐analysis	PubMed, PsycInfo, and Google Scholar	01/1990–04/2018	N = 101; (1) studies measured optimism: N = 52 (quantitative studies) (2) studies measured coping: N = 43 (quantitative studies) (3) studies measured resilience: N = 6 (quantitative studies)	For studies measured resilience: Not specified	Women diagnosed with breast cancer
George et al. (2023)	To describe resilience of older cancer patients in terms of physical, cognitive, and psychosocial aspects	Scoping review	PubMed	From database inception–01/2022	N = 29; 23 prospective, 4 qualitative, analyses, 1 retrospective, 1 other	12 United States, 7 China, 3 Australia, 2 each from: Germany, United Kingdom. 1 each from: South Korea, Israel, Switzerland	Adults diagnosed with mixed types of cancers
Greup et al. (2018)	To synthesise evidence of posttraumatic growth and resilience experiences, their associated factors, and interventions in adolescent and young adults diagnosed with cancer	Literature review	Embase, PsycInfo, PubMed, Web of Science, Cochrane Library, CINAHL, reference lists	From database inception–11/2016	N = 13; 10 quantitative (8 cross‐sectional, 2 intervention design), 3 qualitative	6 United States, 1 each from: China, New Zealand, United Kingdom, Portugal, Germany, Canada, Italy	Adolescent and young adult aged 12–39 years diagnosed with multiple types of cancer
Lau et al. (2021)	To examine the definitions and associated factors of psychological resilience in palliative patients with advanced cancer	Systematic review	PubMed, CINAHL, Scopus, PsycInfo, reference lists	From database inception–08/2020	N = 15; 10 qualitative designs, 5 quantitative (4 cross‐sectional, 1 randomised controlled trial)	4 Norway, 3 United States, 2 Australia. 1 each from: China, South Korea, Brazil, India, Germany, Canada	Adults diagnosed with various types of cancers. The common ones were: (1) colorectal cancer, (2) lung cancer, and (3) others
Ludolph et al. (2019)	To (1) investigate the extent of influence of potential moderators on the effects of interventions to improve resilience and posttraumatic growth, and (2) explore the stability of the effects of the interventions in long run	Narrative review	PubMed and Cochrane Library (CENTRAL), and reference lists	01/1990–05/2018	N = 22 (randomised controlled trials)	4 China, 3 each from: South Korea, United States, Iran, 2 Canada. 1 each from: Australia, New Zealand, Italy, Hungary, Netherlands, Portugal, Spain	Adults diagnosed with: (1) breast cancer, (2) colorectal cancer, (3) gastric cancer, (4) prostate cancer and (5) others
Ruiz Pena et al. (2021)	To analyse and describe the health‐related quality of life scales and resilience scales commonly used in gynaecological and breast cancer patients to identify their limitations	Systematic review	PubMed, MEDLINE, Cochrane Database, and Google Scholar	2000–2020	N = 41; Quantitative design and review articles (numbers were not specified)	Not specified	Adults diagnosed with: (1) gynaecological cancer, and (2) breast cancer
Seiler and Jenewein (2019)	To (1) investigate factors that can facilitate and weaken resilience and posttraumatic growth in people diagnosed with cancer, (2) explore relations between individual resilience and posttraumatic growth, mental health outcomes, and (3) explore the influence and implications of resilience and posttraumatic growth in cancer patient's recovery process	Literature review	PubMed	From database inception–05/2018	N = 154; 56 cross‐sectional, 47 prospective, 37 review articles, 6 book chapter, 4 meta‐analysis, 2 retrospective, 1 research article, 1 validity and reliability study	71 United States, 14 China, 12 Canada, 7 Germany, 6 each from United Kingdom, Switzerland, 5 Sweden. 3 each from Israel, Italy, Finland. 2 each from Brazil, France, Ireland, Austria, India, Turkey, Australia, Norway. 1 each from Iran, South Korea, Belgium, Japan, Netherlands, Greece, Romania, Malaysia	Participants had multiple types of cancer
Sihvola, Kuosmanen, and Kvist (2022)	To explore resilience and associated factors in adults diagnosed with colorectal cancer	Systematic review	CINAHL, Scopus, PubMed and reference lists	2009–2021	N = 11; 9 cross‐sectional, 2 intervention design	5 China, 3 Israel, 2 Brazil, 1 Turkey	Adults diagnosed with colorectal cancer
Sihvola, Kiwanuka, and Kvist (2023)	To investigate the fundamental components of patient education approaches for facilitating resilience in adult cancer patients	Integrative review	PubMed, Scopus, CINAHL and PsycInfo	01/2010–04/2021	N = 9; 6 randomised controlled trials, 2 quasi‐experimental design, 1 longitudinal study	5 China, 2 South Korea. 1 each from: Switzerland, Japan	Adults diagnosed with various types of cancers. The common ones were: (1) breast cancer, (2) colorectal cancer, (3) gastric cancer
Tamura et al. (2021)	To identify (1) the relationships between resilience and factors related to mental health (including anxiety, depression and quality of life) in adults with cancer, and (2) factors associated with resilience of adult cancer patients	Systematic review	PubMed, CINAHL, Psychology Database, and ICHUSHI Web databases	2014–2019	N = 39; 39 cross‐sectional	14 China, 4 Australia, 3 Iran, 2 each from: Israel, Republic of Macedonia, Brazil, Greece. 1 each from: Switzerland, United States, India, Romania, Poland, Ireland, South Korea, United Kingdom, Turkey, Spain	Adults diagnosed with various types of cancers. The common ones were: (1) breast cancer, (2) colon cancer, (3) prostate cancer, (4) gastric cancer, (5) lung cancer, (6) bladder cancer, (7) liver cancer, (8) oral cavity cancer, (9) head and neck cancer and (10) others

4.2. Quality of the Included Reviews

Overall, the quality of the included articles varied, ranging from moderate (n = 7) to high (n = 7) quality. Among reviews with comparatively lower quality, some lacked detailed descriptions of the approach employed to minimise bias in data extraction. Additionally, some systematic reviews did not present a quality appraisal of the included studies. Details of the quality appraisal are presented in Table S2.

4.3. The Components of Resilience of Adults With Cancer

All included reviews described a conceptualisation of resilience in adults with cancer (Table 2). Most researchers provided one definition of resilience whereas Greup et al. (2018) and Ludolph et al. (2019) respectively proposed two definitions of resilience. The conceptualisation of resilience showed large variability. The majority of definitions were broad and only revealed partial features of resilience. Four common components were identified from these conceptualisations of resilience: (1) available individual resources; (2) access to social resources; (3) adaptive coping ability; (4) ability to regain mental health and well‐being.

TABLE 2.

Definitions of resilience and common features.

Author, year	Definition of resilience	Common feature(s) a
Aizpurua‐Perez and Perez‐Tejada (2020)	‘Resilience refers to a dynamic process that promotes a successful adaptation to cancer‐related adversity’.	Adaptive coping ability
Ang et al. (2023)	‘Resilience can be comprehended through various perspectives such as character traits, processes, or outcomes, and correlates with the capacity to rebound from adversities’.	Available individual resources Adaptive coping ability Ability to regain mental health and well‐being
Ding et al. (2024)	Resilience is ‘an outcome indicator’ after intervention.	Ability to regain mental health and well‐being
Eicher et al. (2015)	Resilience is ‘a dynamic process of facing adversity related to the cancer experience’.	Adaptive coping ability
Fasano et al. (2020)	‘Resilience is a set of characteristics such as self‐efficacy, adaptability to change, and an approach‐orientation coping style’.	Available individual resources
George et al. (2023)	‘Resilience, the ability to respond to stressors by maintaining or rapidly returning to normal homeostasis, serves as a new paradigm to improve the care of older adults'.	Ability to regain mental health and well‐being
Greup et al. (2018)	Resilience is ‘a balance of several factors, including stress and coping, goals, optimism, finding meaning, connection, and belonging’. ‘a mediator in the relationship between symptom distress and health‐related quality of life’.	Ability to regain mental health and well‐being
Lau et al. (2021)	Resilience has five features: buffering—‘being able to prevent or reduce the negative impact of stressors’ adaptation—‘the ability to adapt to adversities or life events (i.e., stressors)’ resources—‘the use of the individual's psychosocial resources to deal with stressors’ recovery—‘a return to the state that the individual was in before encountering the stressor’ growth—‘positive biopsychosocial development and/or benefits to the individual's well‐being’.	Ability to regain mental health and well‐being (buffering, recovery, growth) Adaptive coping ability (adaptation) Available individual resources (resources) Access to social resources (resources)
Ludolph et al. (2019)	Resilience is: ‘the ability to maintain or rapidly regain mental health during or after stressful life experiences’. ‘the result of adaptation to stressors and is determined, at least partially, by multiple factors, such as self‐esteem, realistic optimism, and cognitive flexibility’.	Ability to regain mental health and well‐being Available individual resources
Ruiz Pena et al. (2021)	‘The concept of resilience consists of the set of qualities, resources or strengths that favour individuals to progress by successfully facing adversity’.	Available individual resources Access to social resources
Seiler and Jenewein (2019)	‘Resilience is an individual's ability to maintain or restore relatively stable psychological and physical functioning when confronted with stressful life events and adversities'.	Ability to regain mental health and well‐being
Sihvola, Kuosmanen, and Kvist (2022)	‘Resilience was identified as a mediator in the positive or negative aspects of illness’.	Ability to regain mental health and well‐being
Sihvola, Kiwanuka, and Kvist (2023)	‘Resilience among cancer patients is a process that helps them adjust to live with cancer’.	Adaptive coping ability
Tamura et al. (2021)	Resilience is ‘the mental recuperative strength that works when people are faced with difficult situations'.	Available individual resources

^a Common feature(s) refer to the themes that identified from the definition(s) of resilience.

Six reviews reported available individual resources as a key component of resilience (Ang et al. 2023; Fasano et al. 2020; Lau et al. 2021; Ludolph et al. 2019; Ruiz Pena et al. 2021; Tamura et al. 2021). Available individual resources refer to personal psychological characteristics and resources that can be drawn on by individuals in managing adversities related to their illness. Examples include self‐efficacy, self‐esteem, optimism, perseverance, adaptability to change and cognitive flexibility (Fasano et al. 2020; Ludolph et al. 2019). Apart from individual resources, two reviews also emphasised the importance of access to social resources in individual resilience (Lau et al. 2021; Ruiz Pena et al. 2021). This includes individuals' social connections (e.g., connections with family and friends) and the social support they provide (Lau et al. 2021), which helps individuals to successfully respond to adversity. Five reviews viewed individuals' adaptive coping ability as an important feature of resilience (Aizpurua‐Perez and Perez‐Tejada 2020; Ang et al. 2023; Eicher et al. 2015; Lau et al. 2021; Sihvola, Kiwanuka, and Kvist 2023), Adaptive coping ability involves the ability to use various coping strategies such as active coping, positive acceptance and problem‐focused coping (Aizpurua‐Perez and Perez‐Tejada 2020; Eicher et al. 2015) to respond to adversity. There were also a number of reviews that reported an individual's ability to regain mental health and well‐being as a critical part of resilience. This ability primarily manifests in two aspects: the ability to restore a relatively stable psychological state following adversity (Ang et al. 2023; George et al. 2023; Greup et al. 2018; Lau et al. 2021; Ludolph et al. 2019; Seiler and Jenewein 2019), and the ability to mitigate the negative psychological impacts of cancer and related mental distress as well as promote positive psychological functioning (Ding et al. 2024; Lau et al. 2021; Sihvola, Kuosmanen, and Kvist 2022). George et al. (2023) and Ludolph et al. (2019) also identified the timeliness of reaching a balanced state of well‐being was a key characteristic of resilience.

4.4. Resilience Measures Used in Adults With Cancer

Twenty resilience measurement tools were identified from all included reviews of studies with adults with cancer (Table 3). Some were original measurement tools while others were adapted from the original measurement tools. The majority (≥ 86%) of reviews reported the 10‐item Connor‐Davidson Resilience Scale (CD‐RISC) (Aizpurua‐Perez and Perez‐Tejada 2020; Ang et al. 2023; Eicher et al. 2015; Fasano et al. 2020; George et al. 2023; Greup et al. 2018; Lau et al. 2021; Ludolph et al. 2019; Ruiz Pena et al. 2021; Seiler and Jenewein 2019; Sihvola, Kuosmanen, and Kvist 2022; Sihvola, Kiwanuka, and Kvist 2023; Tamura et al. 2021) and 25‐item CD‐RISC (Aizpurua‐Perez and Perez‐Tejada 2020; Ang et al. 2023; Eicher et al. 2015; George et al. 2023; Greup et al. 2018; Lau et al. 2021; Ludolph et al. 2019; Ruiz Pena et al. 2021; Seiler and Jenewein 2019; Sihvola, Kuosmanen, and Kvist 2022; Sihvola, Kiwanuka, and Kvist 2023; Tamura et al. 2021). Approximately 65% of the reviews reported the 25‐item Resilience Scale (RS) (Ang et al. 2023; Ding et al. 2024; Eicher et al. 2015; Greup et al. 2018; Lau et al. 2021; Seiler and Jenewein 2019; Sihvola, Kuosmanen, and Kvist 2022; Sihvola, Kiwanuka, and Kvist 2023; Tamura et al. 2021) and 43% reported the 14‐item RS (Aizpurua‐Perez and Perez‐Tejada 2020; Ding et al. 2024; Eicher et al. 2015; Ruiz Pena et al. 2021; Sihvola, Kuosmanen, and Kvist 2022; Tamura et al. 2021). Several reviews identified other resilience measures, such as the Chinese adapted version of the 25‐item CD‐RISC (Ang et al. 2023; Ding et al. 2024; George et al. 2023; Sihvola, Kiwanuka, and Kvist 2023; Tamura et al. 2021), the Chinese adapted version of the 14‐item RS (Seiler and Jenewein 2019; Tamura et al. 2021), the Bharathiar University Resilience Scale (Lau et al. 2021; Seiler and Jenewein 2019; Tamura et al. 2021), the Ego‐Resiliency Scale (Aizpurua‐Perez and Perez‐Tejada 2020; Tamura et al. 2021), the Resilience Measurement Scale (Aizpurua‐Perez and Perez‐Tejada 2020; Tamura et al. 2021), the 2‐item CD‐RISC (Ang et al. 2023; Ludolph et al. 2019) and the Brief Resilience Scale (BRS) (Seiler and Jenewein 2019; Tamura et al. 2021).

TABLE 3.

Summary of measurement instruments of resilience used in adults with cancer in relevant included reviews.

Instrument	Relevant reviews	Context of the instrument developed	Target population	Number of domain (items)	Available individual resources	Involved components of resilience		Ability to regain mental health and well‐being
						Access to social resources	Adaptive coping ability
10‐item CD‐RISC (Campbell‐Sills and Stein 2007)	Aizpurua‐Perez and Perez‐Tejada (2020); Ang et al. (2023); Eicher et al. (2015); Fasano et al. (2020); George et al. (2023); Greup et al. (2018); Lau et al. (2021); Ludolph et al. (2019); Ruiz Pena et al. (2021); Seiler and Jenewein (2019); Sihvola, Kuosmanen, and Kvist (2022); Sihvola, Kiwanuka, and Kvist (2023); Tamura et al. (2021).	United States	Young adults (mean age: 18.8 ± 2.2 years, undergraduates)	1 (10)	Example of relevant items: Tries to see humorous side of problems; Thinks of self as strong person; Able to adapt to change; Can achieve goals despite obstacle; Can deal with whatever comes			Example of relevant items: Tend to bounce back after illness or hardship Coping with stress can strengthen me
25‐item CD‐RISC (Connor and Davidson 2003)	Aizpurua‐Perez and Perez‐Tejada (2020); Ang et al. (2023); Eicher et al. (2015); George et al. (2023); Greup et al. (2018); Lau et al. (2021); Ludolph et al. (2019); Ruiz Pena et al. (2021); Seiler and Jenewein (2019); Sihvola, Kuosmanen, and Kvist (2022); Sihvola, Kiwanuka, and Kvist (2023); Tamura et al. (2021)	United States	Adults (mean age: 43.8 ± 15.3 years, general population, and patients with non‐cancer illnesses)	5 (25)	Relevant dimensions (example items): Personal competence, high standards, tenacity (e.g., Not easily discouraged by failure; You can achieve your goals); Self‐trust, tolerance, strengthening effects of stress (e.g., Can handle unpleasant feelings); Positive acceptance of change, secure relationships (e.g., Able to adapt to change; Past success gives confidence for new challenge; Can deal with whatever comes); Sense of control (e.g., Strong sense of purpose; In control of your life); Spirituality influence (e.g., Sometimes fate or God can help)	Relevant dimensions (example items): Positive acceptance of change, secure relationships (e.g., Close and secure relationship); Sense of control (e.g., Know where to turn for help)	Relevant dimensions (example items): Self‐trust, tolerance, strengthening effects of stress (e.g., Prefer to take the lead in problem‐solving; Under pressure, focus and think clearly; Have to act on a hunch)	Relevant dimensions (example items): Positive acceptance of change, secure relationships (e.g., Tend to bounce back after illness or hardship) Self‐trust, tolerance, strengthening effects of stress (e.g., Coping with stress strengthens)
25‐item RS (Wagnild and Young 1993)	Ang et al. (2023); Ding et al. (2024); Eicher et al. (2015); Greup et al. (2018); Lau et al. (2021); Seiler and Jenewein (2019); Sihvola, Kuosmanen, and Kvist (2022); Sihvola, Kiwanuka, and Kvist (2023); Tamura et al. (2021)	United States	Older adults (mean age: 71.1 ± 6.5 years, community‐ dwelling population)	2 (25)	Relevant dimensions (example items): Personal competence (e.g., Self‐confidence, Self‐reliance, Mastery, Independence, Determination, Ingenuity, and Perseverance); Acceptance of self and life (e.g., Adaptability, Flexibility, A well‐adjusted perspective of life)
14‐item RS (Wagnild 2009)	Aizpurua‐Perez and Perez‐Tejada (2020); Ding et al. (2024); Eicher et al. (2015); Ruiz Pena et al. (2021), Sihvola, Kuosmanen, and Kvist (2022); Tamura et al. (2021)	United States	Middle‐aged and older adults	5 (14)	Relevant dimensions (example items): Self‐reliance (e.g., Ability to cope; Organised; Resourcefulness); Purposeful life (e.g., Pride; Interest/ engagement); Perseverance (e.g., Willpower); Equanimity (e.g., Humour); Existential aloneness (e.g., Self‐regard; Self‐ efficacy)
25‐item CD‐RISC (Chinese adapted version) (Yu and Zhang 2007)	Ang et al. (2023); Ding et al. (2024); George et al. (2023); Tamura et al. (2021); Sihvola, Kiwanuka, and Kvist (2023)	China	Adults (general population)	3 (25)	Relevant dimensions (example items): Tenacity (e.g., Strong sense of purpose; Think of self as strong person; I like challenge); Strength: (e.g., When things look hopeless, I don't give up; Pride in your achievements; Able to adapt to change); Optimism (e.g., See the humorous side of things; Sometimes fate and God can help)	Relevant dimensions (example items): Optimism (e.g., Close and secure relationships); Tenacity (e.g., Know where to turn for help)	Relevant dimensions (example items): Tenacity (e.g., Under pressure, focus and think clearly; Prefer to take the lead in problem‐solving; Have to act on a hunch)	Relevant dimensions (example items): Strength (e.g., Tend to bounce back after illness or hardship, Coping with stress strengthens)
Bharathiar University Resilience Scale (Annalakshmi 2009)	Lau et al. (2021), Seiler and Jenewein (2019), Tamura et al. (2021)	India	Adolescents and young adults (14–20 years)	7 (30)	Example of relevant items: I can handle any critical situation with confidence since I have successfully done so earlier; I can easily revise my plans without accepting defeat when I get stuck up; People say that I have a strong heart which can withstand any disappointment; Even a severe setback can only make me to bend down but never to break down; Challenges are not problems but opportunities for rising to the occasion	Example of relevant items: During times of trouble I sink with feeling helpless	Example of relevant items: I do not waste my time on lamenting over the past however bad it might have been; When the situation is very demanding, I can pull up myself and handle all of it efficiently; When I am in a difficult situation, I can usually find my way out of it	Example of relevant items: I easily break down at the crisis and it takes longer time for me to recover; I cannot recover from frustration for long time; I can recover from a bad mood quickly and easily after facing any sad event; I usually get back to my cheerful self pretty soon no matter what failures occur in my life
2‐item CD‐RISC (Vaishnavi, Connor, and Davidson 2007)	Ang et al. (2023), Ludolph et al. (2019)	United States	Adults (mean age: 43.8 ± 15.3 years, general population and patients with non‐cancer illnesses)	1 (2)	Example of relevant items: Able to adapt to change			Example of relevant items: Tend to bounce back after illness or hardship
14‐item RS (Chinese adapted version) (Tian and Hong 2013)	Seiler and Jenewein (2019), Tamura et al. (2021)	China	Adults with cancer (mean age: 41.0 ± 10.7 years)	2 (14)	Relevant dimensions (example items): Personal competence (e.g., I feel that I can handle many things at a time; I have self‐ discipline; I feel that I can handle many things at a time); Acceptance of self and life (e.g., I usually take things in stride; I can usually find something to laugh about; My life has meaning)		Relevant dimensions (example items): Personal competence (e.g., I can get through difficult times because I have experienced difficulty before)
Ego‐Resiliency Scale (Block and Kremen 1996)	Aizpurua‐Perez and Perez‐Tejada (2020), Tamura et al. (2021)	United States	Young adults (18‐ and 23‐ year‐old, general population)	1 (14)	Example of relevant items: I like to do new and different things; I would be willing to describe myself as a pretty “strong” personality; My daily life is full of things that keep me interested			Example of relevant items: I quickly get over and recover from being startled; I get over my anger at someone reasonably quickly
Resilience Measurement Scale (Ogińska‐Bulik and Juczyński 2008)	Aizpurua‐Perez and Perez‐Tejada (2020), Tamura et al. (2021)	Poland	Adults (age range from 19 to 65 years, general population)	5 (25)	Relevant dimensions: Perseverance and determination in action; Openness to experience and sense of humour; Tolerance of failure and viewing life as a challenge; Optimistic attitude towards life and the ability to mobilise oneself in difficult situations		Relevant dimensions: Ability to cope and tolerance of negative emotions; Openness to experience and sense of humour
BRS (Smith et al. 2008)	Seiler and Jenewein (2019), Tamura et al. (2021)	United States	Adults (age range from 19 to 62 years, undergraduates, and patients with non‐ cancer illnesses)	1 (6)	Example of relevant items: I usually come through difficult times with little trouble			Example of relevant items: I tend to bounce back quickly after hard times; It does not take me long to recover from a stressful event; It is hard for me to snap back when something bad happens; I tend to take a long time to get over set‐backs in my life
Chinese Resilience Scale (Hu 2008)	Tamura et al. (2021)	China	Adolescents (mean age: 16.5 ± 4.8 years, general population)	5 (27)	Relevant dimensions (example items): Positive thinking (e.g., I think adversity has a motivating effect on people; Adversity sometimes helps growth)	Relevant dimensions (example items): Help seeking (e.g., I have a friend of the same age whom I can tell her/him about my difficulties; When I'm in trouble and need help, I don't know who to go to); Family support (e.g., My parents lack confidence and moral support for me; My parents always encourage me to do my best)	Relevant dimensions (example items): Goal planning (e.g., When faced with difficulties, I usually make a plan and solution; When faced with difficulties, I will concentrate all my energy. Help seeking (e.g., When I have difficulties, I will take the initiative to talk to others) Affect control (e.g., It's hard for me to control my unpleasant emotions; I am able to adjust my emotions very well in a short period of time)
Internal Resilience Factor Scale (García‐Robles and Sayers‐Montalvo 2010)	Aizpurua‐Perez and Perez‐Tejada (2020)	United States	Adults (mean age: 42.3 ± 10.6 years, general population)	7 (34)	Relevant dimensions: Spirituality; Satisfaction; Emotional stability; Optimism; Autonomy; Introspection		Relevant dimensions: Problems management
Mexican Resilience Scale (Palomar‐Lever & G'omez‐Valdez, 2010)	Aizpurua‐Perez and Perez‐Tejada (2020)	Mexico	Adults (age range from 18 to 25 years, general population)	5 (43)	Relevant dimensions: Strength and self‐ confidence (e.g., I am a strong person; I control my life) Social competence (e.g., I enjoy being with other people; It is easy for me to make new friends); Structure (the ability to organise self, plan activities and time, set rules and engage in activities even though in difficult times)	Relevant dimensions: Strength and self‐ confidence (e.g., I know where to look for help); Family support (e.g., have a good relationship with my family; I enjoy being with my family); Social support (e.g., I have some friends/relatives who support me; There is always someone who can help me when I need it)	Relevant dimensions: Strength and self‐confidence (e.g., I know that I have skills; No matter what happens, I will always find a solution)
Psychological Resilience Scale (Oshio, Nakaya, and Kaneko 2002)	Aizpurua‐Perez and Perez‐Tejada (2020)	Japan	Adults (mean age: 20.22 ± 0.85 years, university students)	3 (21)	Relevant dimensions (example items): Novelty seeking (e.g., I like trying various things; I like new and unusual things; Even if there are difficulties, they are worth living); Positive future orientation (e.g., I believe that good things will surely happen in my future; I think the future outlook is bright; have hope for one's future)		Relevant dimensions (example items): Emotional regulation (e.g., I can control my emotions; When I feel angry, I can't control it)
RSA (Friborg et al. 2003)	Ding et al. (2024)	Norway	Adults received psychotherapy (mean age: women: 33.7 years, men: 36.2 years)	5 (37)	Relevant dimensions: Personal competence Social competence	Relevant dimensions: Family coherence Social support	Relevant dimensions: Personal structure (e.g., I keep up my daily routines even at difficult times; I prefer to plan my actions)
29‐item RSA (Chinese adapted version) (Wang 2007)	Aizpurua‐Perez and Perez‐Tejada (2020)	China	Adults with burn injury	5 (29)	Relevant dimensions: Personal structure; Personal competence; Social competence	Relevant dimensions: Family cohesion; Social resources
33‐item RSA (Turkish adapted version) (Basim and Cetin 2011)	Ang et al. (2023)	Turkey	University students (age range from 18 to 25 years); Bank staff (age range from 21 to 27 years)	6 (29)	Relevant dimensions: Perception of self; Perception of future; Social competence; Structured style	Relevant dimensions: Family cohesion; Social resources
Sukemune‐Hiew Resilience Test (Satoh and Sukemune 2009	Sihvola, Kiwanuka, and Kvist (2023)	Japan	Adults (general population)	3 (27)	Relevant dimensions: Self‐efficacy; Sociability	Relevant dimensions: Social support
52‐item RS (Chilean adapted version) (Ocampo et al. 2011)	Aizpurua‐Perez and Perez‐Tejada (2020)	Chile	Adolescents and adults (age range from 15 to 65 years, general population)	8 (52)	Relevant dimensions: Autonomy; Personal strength; Goals; Meaning in life; Self‐esteem; Affectivity	Relevant dimensions: Social support; Bonds

Note: Underlined texts refer to dimensions that involve multiple components of resilience.

Abbreviation: RSA = Resilience Scale for Adults.

Over half of these identified resilience measures were developed in the context of Western culture, with most (n = 8) designed for the American population. There were seven tools developed or adapted for Asian populations, with most from China (n = 4) and Japan (n = 2). Most resilience tools were developed for the general population, except for the Chinese adapted version of the 14‐item RS (Tian and Hong 2013), which was designed for people diagnosed with cancer. Eighty‐five per cent (n = 17) of the measurement tools were developed for adults, and 5% (n = 1) of the instruments (i.e., Chinese Resilience Scale) were designed for adolescents. Two instruments (Bharathiar University Resilience Scale; Chilean adapted version of RS) were also developed for both adolescents and adults. The number of dimensions of identified resilience measures ranged from one to eight. We mapped the dimensions of all resilience measures against the four identified components of resilience across reviews and found that most of the instruments measured only partial features of resilience. Among these tools, the original and Chinese versions of the 25‐item CD‐RISC, as well as the Bharathiar University Resilience Scale, covered the four identified components of resilience (Figure 2). All the measurement tools involved the assessment of available individual resources. Fifty per cent of the instruments measured access to social resources (n = 10) and adaptive coping ability (n = 10). Less than 40% (n = 7) of the instruments evaluated the ability to regain mental health and well‐being.

FIGURE 2.

Number of involved components of resilience in identified tools.

4.4.1. Measurement of, Available Individual Resources,

An individual's available psychological resources assessed in each resilience measurement tool showed considerable heterogeneity. Examples of some commonly measured resources included psychological strength (Annalakshmi 2009; Block and Kremen 1996; Campbell‐Sills and Stein 2007; Connor and Davidson 2003; Ocampo et al. 2011; Palomar‐Lever, and G'omez‐Valdez 2010; Yu and Zhang 2007), confidence (Annalakshmi 2009; Connor and Davidson 2003; Palomar‐Lever, and G'omez‐Valdez 2010; Wagnild and Young 1993), sense of mastery (Connor and Davidson 2003; Wagnild and Young 1993), perseverance (Connor and Davidson 2003; Wagnild 2009; Wagnild and Young 1993; Yu and Zhang 2007), flexibility (Annalakshmi 2009; Wagnild and Young 1993), meaning making (Ocampo et al. 2011; Tian and Hong 2013), optimism (García‐Robles and Sayers‐Montalvo 2010; Yu and Zhang 2007), self‐efficacy (Satoh and Sukemune 2009; Wagnild 2009), spirituality (Connor and Davidson 2003; García‐Robles and Sayers‐Montalvo 2010; Yu and Zhang 2007), social competence (i.e., ability to interact with others) (Basim and Cetin 2011; Friborg et al. 2003; Palomar‐Lever & G'omez‐Valdez, 2010; Wang 2007), determination (Wagnild and Young 1993) and openness to new things (Block and Kremen 1996; Oshio, Nakaya, and Kaneko 2002). To date, developers of resilience measures have not reached an agreement on which individual psychological resources play relatively more important roles in promoting resilience, even within the same cultural context.

4.4.2. Measurement of, Access to Social Resources,

Some resilience measures, for instance, the original and Chinese versions of the 25‐item CD‐RISC, Chinese and Mexican Resilience Scales, original and Turkish version of the 33‐item RSA, Sukemune‐Hiew Resilience Test and Chilean version of the 52‐item RS, also involved the assessment of individuals' access to social resources, such as close and secure relationships (Connor and Davidson 2003; Ocampo et al. 2011; Yu and Zhang 2007), people to whom one can turn for help (e.g., family, friends) (Connor and Davidson 2003; Hu 2008; Yu and Zhang 2007), family cohesion (Basim and Cetin 2011; Friborg et al. 2003; Wang 2007) and social support (Friborg et al. 2003; Ocampo et al. 2011; Palomar‐Lever, and G'omez‐Valdez 2010; Satoh and Sukemune 2009). Of note, none of the existing resilience measures covered all these social resources in the assessment of individual resilience.

4.4.3. Measurement of ‘Adaptive Coping Ability’

Individuals' ability to adaptively cope was evaluated in 10 measurement tools of resilience, including the original and Chinese versions of the 25‐item CD‐RISC (Connor and Davidson 2003; Yu and Zhang 2007), Bharathiar University Resilience Scale (Annalakshmi 2009), the Chinese version of the 14‐item RS (Tian and Hong 2013), Resilience Measurement Scale (Ogińska‐Bulik and Juczyński 2008), Chinese Resilience Scale (Hu 2008), Internal Resilience Factor Scale (García‐Robles and Sayers‐Montalvo 2010), Mexican Resilience Scale (Palomar‐Lever, and G'omez‐Valdez 2010), Psychological Resilience Scale (Oshio, Nakaya, and Kaneko 2002) and RSA (Friborg et al. 2003). This was mainly exhibited through individuals' ability to use various coping strategies to resolve practical problems and manage negative emotions. Some instruments of resilience focused on assessing strategies used for resolving practical problems, such as concentrating and maintaining clarity of thought when facing adversity (Connor and Davidson 2003; Hu 2008), making decisions based on one's intuition (Connor and Davidson 2003; Yu and Zhang 2007), actively seeking others' help (Hu 2008) and devising plans and solutions (Friborg et al. 2003; Hu 2008). Others also evaluated the approaches used to manage negative emotions, for instance tolerating and controlling negative emotions (Ogińska‐Bulik and Juczyński 2008; Oshio, Nakaya, and Kaneko 2002), as well as focusing on the present (Annalakshmi 2009). The Chinese version of the 14‐item RS (Tian and Hong 2013) and the Resilience Measurement Scale (Ogińska‐Bulik and Juczyński 2008) also integrated individuals' past experiences of managing adversity in life into the assessment of resilience.

4.4.4. Measurement of the Ability to, Regain Mental Health and Well‐Being,

Some resilience measures also assessed individuals' ability to recover a relatively stable state of mental well‐being and promote positive psychological functioning. Specifically, measurement tools such as the original and adapted versions of the CD‐RISC (Campbell‐Sills and Stein 2007; Connor and Davidson 2003; Vaishnavi, Connor, and Davidson 2007; Yu and Zhang 2007), the Bharathiar University Resilience Scale (Annalakshmi 2009), the Ego‐Resiliency Scale (Block and Kremen 1996), the BRS (Smith et al. 2008) and the Chinese Resilience Scale (Hu 2008) involved the assessment of individuals' ability to restore psychological haemostasis when confronted with adversity. Interestingly, all versions of the CD‐RISC (including the original and adapted versions) primarily focused on an individual's ability to restore mental well‐being following adversity, while other measurement tools emphasised more on the time spent for restoration and recovery. With respect to the terms used to describe the process of regaining psychological homeostasis after adversity, ‘bounce back’ was found to be commonly used in most resilience measures. Additionally, several original and adapted versions of the CD‐RISC (e.g., the 10‐item and 25‐item CD‐RISC, the Chinese version of the 25‐item CD‐RISC) also evaluated an individual's capability to promote positive psychological functioning. These instruments assessed this by evaluating the extent to which individuals perceived themselves as becoming mentally stronger following adversity (i.e., strengthening effects of stress, a concept where exposure to manageable levels of stress can potentially enhance an individual's capacity to cope with future stressors) (Campbell‐Sills and Stein 2007; Connor and Davidson 2003; Yu and Zhang 2007).

5. Discussion

This umbrella review clarified the components of resilience of adults with cancer by summarising and analysing the definitions of resilience in the 14 relevant review articles. Our analysis shows that available individual resources, access to social resources, adaptive coping ability and ability to regain mental health and well‐being play key roles in supporting individuals to positively adapt and respond to cancer and its related adversities. In addition, we identified 20 resilience measures used by adult cancer patients from the included reviews. Most of these tools were developed for the non‐cancer population and only involved the assessment of partial features of resilience of the cancer population.

5.1. Available Individual Resources

Despite the large variability in the conceptualisations of individual resilience, the majority of researchers acknowledged that personal factors and resources were an essential part of this complex concept. A range of psychological factors and characteristics were identified from the existing resilience measures used in adults with cancer, such as confidence, sense of mastery, perseverance, optimism, flexibility, self‐efficacy, spirituality and social competence. In a review that investigated factors determining resilience of cancer patients, psychological factors such as optimism, positive emotions, sense of control, hardiness and spirituality were identified as vital components of resilience of cancer patients (Seiler and Jenewein 2019). Additionally, social competence, as an important component of resilience (Mesman, Vreeker, and Hillegers 2021), can also protect individuals from negative emotions (e.g., loneliness) and facilitate their adaptation (Jakobsen et al. 2020; Ma 2012; Sakız, Mert, and Sarıçam 2021). According to our analysis of identified resilience measures, there was a lack of agreement on the relative importance of psychological resources in promoting individuals' resilience among instrument developers, even within the same cultural context. Two recent systematic reviews of qualitative studies with cancer patients' perceptions of resilience identified the essential roles of spirituality, perseverance, motivation, positive mindset and acceptance of illness in their adaptation to cancer (Khok et al. 2024; Tan, Beatty, and Koczwara 2019). Incorporating these factors into assessment of the ‘available individual resources’ component may assist healthcare providers in identifying specific psychological resources that cancer patients may need and facilitate early referral to psychosocial support services.

5.2. Access to Social Resources

Resilience is not only about personal characteristics and resources but also includes the social support and connections that enable individuals to adapt positively following adversity. Resilience theorists and researchers such as King and Rothstein (2010), as well as Luo, Eicher, and White (2020), underscored that the interaction between individual factors and external resources including social connections is a vital part of the resilience process. However, only two included reviews mentioned social resources in their conceptualisations of resilience, and less than 50% of the identified resilience measures considered the evaluation of external supports and resources. Our analysis of diverse measurement tools of resilience found that social resources were primarily assessed through close and secure interpersonal relationships, family cohesion and social support. A cross‐sectional study investigating the impact of secure and insecure (i.e., anxious, avoidant and disorganised) attachment patterns on the psychological resilience of cancer patients shows that individuals who have close and secure attachments tend to have higher levels of resilience (Basal et al. 2020). Foster, Mitchell et al. (2019), who explored resilience‐promoting factors for parents with severely injured children during the acute hospitalisation period, also found the important role that close and supportive interpersonal relationships play in facilitating parents' well‐being. Further, previous research indicates that strong family bonds have a positive impact on cancer patients' adaptation process (Yang et al. 2023). Social support, as one of the key components of resilience, has also been shown to significantly contribute to improved health outcomes and reduced psychological distress in adults with cancer (Hofman et al. 2021; Seiler and Jenewein 2019; Tian et al. 2021). Existing qualitative studies on resilience in cancer patients have also demonstrated the importance of close bonds and interpersonal relationships, as well as social support which is primarily obtained from family, peers and healthcare facilities (Khok et al. 2024; Tan, Beatty, and Koczwara 2019). When evaluating the access to social resources component, it is recommended to place greater focus on close and supportive interpersonal relationships, family cohesion and social support (from family, peers and healthcare facilities), as these factors can help healthcare professionals to identify specific areas where support may be lacking and to provide targeted interventions.

5.3. Adaptive Coping Ability

Adaptive coping ability also plays a crucial role in the dynamic adaptation process of resilience since it provides individuals with the necessary skills to effectively manage and adapt to adversity. Among the 20 identified measurement tools of resilience, some assessed coping strategies used to resolve practical problems, while others evaluated approaches to manage negative emotions. Empirical studies have found that adaptive coping strategies are positively associated with resilience of patients with cancer (Macía et al. 2021, 2020). Among them, problem‐solving coping strategies and making action plans have been found to facilitate individuals' active coping (Helmreich et al. 2017). In addition, the results of a recently published review that systematically reviewed literature investigating the relationship between emotion regulation and psychological resilience show that emotion regulation may contribute to emotion‐ and problem‐focused coping, thus promoting individuals' resilience (Polizzi and Lynn 2021). Based on the analysis of resilience measures in the current review, two instruments also included an assessment of individuals’ past experiences of managing adversity in life, which may potentially influence their resilience since people learn coping strategies that help them respond to future adversity. This is consistent with the results of previous studies suggesting that past life experiences may have a positive impact on individuals' ability to recovery (Cheung and Kam 2012; Hayman, Kerse, and Consedine 2017). Morse and colleagues, who developed a resilience framework for nursing and healthcare, also claimed that an individual's ability to recover from a life‐changing diagnosis partially depends on their past experiences and skills (Morse et al. 2021). Khok et al. (2024) and Tan, Beatty, and Koczwara (2019) synthesised evidence from qualitative studies on resilience from cancer patients' perspectives and found that resilient individuals were more likely to focus on the present and use positive active coping strategies to manage illness‐related adversity. These strategies primarily included seeking help from others, setting and planning goals (goal‐based coping), actively adjusting their mindset through stress management techniques and attempting to maintain a sense of normalcy. When assessing the ‘adaptive coping ability’ component, healthcare professionals are recommended to consider individuals' problem‐solving ability (including focusing on the present, seeking help, setting and planning goals, attempting to maintain a sense of normalcy), emotional management ability (including actively adjusting mindset using stress management techniques) and past experiences of managing adversity in life, as these factors may help identify key coping skills that cancer patients might need support with and facilitate the provision of targeted training.

5.4. Ability to Regain Mental Health and Well‐Being

An individual's ability to regain mental health and well‐being is also perceived as a key component of resilience. This is primarily exhibited through one's ability to restore psychological homeostasis, mitigate the negative psychological impacts of adversity and develop positive psychological functioning. Despite various trajectories of psychological resilience being investigated in previous studies (Foster, McCloughen et al. 2019; Rosenberg et al. 2021), they all reflect individuals' ability to regain a relatively stable state, particularly in terms of psychological well‐being. Our analysis found that existing measurement tools of resilience assess the ability to regain psychological homeostasis using two approaches, and the main difference between these approaches lies in whether they consider the speed of recovering from adversity as a part of resilience. Among the conceptualisations of resilience identified from the included reviews, a few also mentioned the timeliness of regaining homeostasis as a feature of resilience (George et al. 2023; Ludolph et al. 2019). However, in the context of major health issues (e.g., cancer), assessing the speed of recovery from the experience of illness may not be applicable due to the complex health conditions in this population. For instance, a longitudinal study that explored the psychosocial trajectories of parents of children with critical injury found that it could take months to recover from this adversity, even for resilient parents (Foster, McCloughen et al. 2019). Similarly, Rosenberg et al. (2021) explored 2‐year trajectories of resilience in adolescent and young adult survivors of cancer who received a resilience‐promoting intervention. The study also found that only approximately one‐third of the study participants reported an improvement in resilience at 6, 12 and 24 months, in both the intervention and control groups. Thus, while evaluating the ability to regain psychological homeostasis in people living with cancer, it is suggested to focus on individuals' ability to recover their mental health rather than the speed of recovery. Our analysis of identified resilience measures found that ‘bounce back’ was a commonly used term to describe the process of regaining psychological homeostasis, however as indicated, ‘bounce back’ is not necessarily always a relevant term due to the fact that it may take some time to recover from some forms of adversity. Contemporary theories of human resilience consider resilience to be a process of sustaining well‐being following adversity through the interaction of factors in multiple systems (i.e., biological, psychosocial and environmental factors) (Ungar et al. 2020). Given that most of the resilience measurement tools used in cancer populations were developed a decade ago or more, and that theoretical perspectives and evidence on individual resilience are evolving over time, there is a need to update older terms (e.g., bounce back) used to describe resilience to ensure the measurement reflects current perspectives. Another aspect demonstrating an individual's ability to regain mental health and well‐being is their ability to mitigate the negative psychological impacts of adversity and promote positive psychological functioning. Empirical studies exploring the relationship between individual resilience and negative affect show that individuals with a higher level of resilience are less affected by stressors and often have a lower level of negative affect (Burns and Anstey 2010; Havnen et al. 2020). A qualitative study that explored the elements of resilience from the perspectives of colorectal cancer patients also found that improved psychological functioning (e.g., enhanced confidence in managing future adversity) is an outcome of a resilient process (Luo, Eicher, and White 2023). Among the identified resilience measures, only a few involved the assessment of an individual's ability to promote positive psychological functioning by measuring the extent to which they perceive themselves as becoming mentally stronger following adversity (i.e., the strengthening effects having managed adversity). A systematic review analysing 32 qualitative studies on cancer patients' experiences and perspectives on resilience found that some resilient individuals also developed deeper connections with others and a strengthened sense of spirituality after experiencing cancer (Tan, Beatty, and Koczwara 2019). Based on the above discussion, when evaluating the ‘ability to regain mental health and well‐being’ component, healthcare providers are recommended to focus on individuals' capacity to recover their mental health, their perception of becoming mentally stronger following adversity and their deepened connections with others and spiritual beliefs.

6. Limitations

Several limitations were identified in this review. Firstly, only review articles written in English were included, which may have resulted in overlooking some relevant articles published in other languages. Additionally, most (93%) of the included reviews searched only English‐language databases, which may introduce selection bias in the primary studies. Among the 14 included reviews, less than one‐fourth focused on a single type of cancer (Aizpurua‐Perez and Perez‐Tejada 2020; Fasano et al. 2020; Sihvola, Kuosmanen, and Kvist 2022). This also limited our ability to further explore potential differences in the features of resilience among people diagnosed with different types of cancer. A recently published review that summarised the research theories and instruments used to investigate resilience of Korean cancer patients also highlighted the influence of culture on interpreting resilience as a complex concept (Lee et al. 2019). Since most primary studies included in the 14 reviews were conducted in North America, the four components of resilience identified from these reviews are more likely to reflect the features of resilient cancer patients in Western cultural contexts. This, to some extent, may also limit the generalisability of our findings. Another limitation is that the relationships among the four components of resilience of adults with cancer are not explored in this review due to the paucity of relevant literature. More cross‐sectional studies are needed to address this gap by examining the relationships among the key components of resilience in cancer patients. In terms of the conceptualisations of resilience proposed in the included reviews and the older measures of resilience used in the cancer population, none of them reflect the interaction process of factors in multiple systems (e.g., biological, psychological, social systems), which aligns with contemporary theories of individual resilience (Ungar and Theron 2020; Ungar et al. 2020). In future resilience research, it is recommended to consider individual resilience from the perspective of an interaction process involving multiple internal and external systems that help individuals sustain or regain mental health and well‐being (Ungar and Theron 2020). For example, a longitudinal study design not only acknowledges resilience as a dynamic process but also enables the exploration of how key components of resilience in cancer patients may change and interact over time.

7. Conclusion

Resilience, as a complex concept and a crucial process in facilitating cancer patients' adaptation to adversity, consists of four core components: available individual resources, access to social resources, adaptive coping ability and ability to regain mental health and well‐being. Our analysis of existing measurement tools for resilience and discussion on the different approaches to assess each element of resilience provide evidence for refining the measurement of resilience of adults with cancer. Since cultural factors may also influence resilience of cancer patients through various pathways, such as coping strategies (Lee et al. 2019), spirituality (Niamhom et al. 2023) and cultural stigma associated with cancer diagnosis (Khok et al. 2024), there is a need to examine the four components of resilience and their corresponding assessment approaches in different cultural backgrounds.

8. Relevance to Clinical Practice

The findings of this umbrella review expand the body of knowledge on individual resilience in adult cancer care. Meanwhile, they may also deepen nurses' and other healthcare professionals' understanding of the features of resilience of cancer patients, which would benefit them in identifying individuals who may need further support and facilitate early intervention or referral to psychosocial support services. Further, our analysis and discussion of existing resilience measures provide resilience researchers with directions on how to evaluate resilience of patients with cancer, laying a foundation for the development of new measurement tools of resilience for adults with cancer. Among existing resilience measures, both the original and Chinese‐adapted versions of the 25‐item CD‐RISC as well as the Bharathiar University Resilience Scale cover the four identified components of resilience. However, the 25‐item CD‐RISC more comprehensively captures the features of resilience compared to the Bharathiar University Resilience Scale and other measurement tools, which may need to be used in combination to fully evaluate resilience. Hence, the 25‐item CD‐RISC (both original and Chinese‐adapted versions) is recommended for use in the cancer population. Additionally, to date, little emphasis has been placed on the role that individual resilience plays in cancer patients' adaptation to their illness in the real world, which also hinders the implementation of resilience interventions for patients in clinical practice. The development of relevant policies is warranted to raise awareness among nurses and other healthcare professionals about promoting resilience of adults with cancer.

Author Contributions

All authors have agreed on the final version and meet at least one of the following criteria: substantial contributions to conception and design, acquisition of data or analysis and interpretation of data D.L., K.F., K.W. Drafting the article or revising it critically for important intellectual content; D.L., K.F., K.W. Final approval of the version to be published D.L., K.F., K.W. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved D.L., K.F., K.W.

Conflicts of Interest

The authors declare no conflicts of interest.

Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/jan.16724.

Supporting information

Table S1.

Table S2.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.