Spiritual well-being associated with personality traits and quality of life in family caregivers of cancer patients

Dyadic Spiritual Coping in Patients With Advanced Cancer and Their Family Caregivers: APIM

CONTEXT

The use of positive and negative spiritual coping has been demonstrated among patients with cancer and their family caregivers. However, the dyadic effects of family caregivers and patients with advanced cancer on spiritual coping, as well as the factors associated with spiritual coping, remain unclear.

OBJECTIVES

To identify the dyadic interactions and factors associated with spiritual coping among patients with advanced cancer and their family caregivers in China.

METHODS

This was a multicenter cross-sectional study conducted in four tertiary hospitals. The participants were 326 dyads of patients with advanced cancer and their family caregivers. A demographic information questionnaire and the Spiritual Coping Scale, General Self-Efficacy Scale, Hospital Anxiety Depression Scale, Spiritual Health Scale, Optimism-Pessimism Scale, Herth Hope Index, and Perceived Social Support Scale were used to examine study variables from January to May 2023. The Actor-Partner Interdependence Model was used to explore the dyadic effects of spiritual coping.

RESULTS

The APIM showed that patients' depression, spiritual health, and social support had actor effects on their spiritual coping, while family caregivers' self-efficacy had a partner effect on patients' spiritual coping. Additionally, family caregivers' self-efficacy, anxiety, and depression had actor effects on their spiritual coping, while patients' self-efficacy, anxiety, and spiritual health had partner effects on family caregivers.

CONCLUSION

Spiritual coping is a dyadic phenomenon in patients with advanced cancer and family caregivers. Improving self-efficacy, spiritual health, and social support, as well as addressing symptoms of anxiety and depression, can enhance spiritual coping abilities and consequently improve quality of life.

The Association Between Psychological Resilience and Spiritual Well-Being Among Family Caregivers of Terminally Ill Cancer Patients: A Multicenter Cross-Sectional Study

Purpose: This study was undertaken to determine the nature of the relationship between psychological resilience and spiritual well-being (SWB) among family caregivers (FCs) of patients with terminal cancer. Methods: This multicenter cross-sectional study included 173 FCs from nine inpatient hospice care units. SWB was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual well-being questionnaire, and various psychosocial variables, including psychological resilience, were also measured. Factors associated with SWB were identified by multivariate regression analysis adjusted for potential covariates. Results: Various factors were found to be associated with the SWB of FCs as determined by total FACIT-Sp-12 scores and the scores of its three domains. FC resilience was significantly associated with SWB as determined by total FACIT-Sp-12 scores and scores of the meaning and peace domains. Conclusion: Assessing FC psychological resilience would help palliative care providers improve their SWB.

Exploring Influence of Spiritual Well-being on Caregiver Burden in Head-and-Neck Malignancy: A Cross-sectional Study

Objectives

Taking care of a patient with head-and-neck malignancy (HNM) entails enormous physical, emotional, cognitive and moral challenges. Caregivers frequently turn to spiritual practices such as prayer, offering and meditation to enhance inner strength and coping ability. Assessment of caregiver burden (CGB) would remain incomplete without considering spiritual well-being (SWB). We set out to assess CGB and SWB in caregivers of patients suffering from HNMs.

Materials and Methods

This cross-sectional study was carried out in a medical college-associated tertiary care centre after approval from the institutional ethics committee. CGB was determined using a translated version of Zarit Burden interview 22. SWB was determined by the spiritual wellbeing scale (SWBS), which was translated into Gujarati and validated. Relevant demographic data were also collected and analysed.

Results

(1) Patient characteristics: (i) Number of participants: 60 (37 males and 23 females). Mean age: 55.56 years, (ii) Mean time since diagnosis: 7.33 months, (iii) Type of malignancy: Buccal mucosae 31, tongue 12, hard palate 7, lip 4, others 6, (iv) Type of family: Nuclear 14, joint 46. Locale: Rural: 36, urban: 24. (2) Caregiver characteristics: (i) Mean age: 44 years, (ii) Educational status: Graduate and above: 19, undergraduate: 22, primary education: 19, (iii) Occupation: Home-makers: 13, skilled: 18, semi-skilled: 18, others: 6. (3) CGB scores: Mean: 35.30 (Standard deviation [SD] = 11.25). Mild, moderate and high burden were reported by 66.7%, 25% and 3.3% caregivers, respectively. 5% of caregivers reported no burden. (4) SWB score: Mean: 81.70 (SD = 14.84). Low, moderate and high SWB scores were observed in 1.7%, 93.3% and 5%, respectively. (5) There was a significant correlation between higher SWB and lower CGB scores at 0.01 level.

Conclusion

Moderate/high SWB was observed in 95% of caregivers regardless of their educational, social and family backgrounds. There was a significant correlation between higher SWB and lower CGB scores.

Psychotherapeutic Applications of the SASB Cluster Analysis of Intrapsychic Behaviors in Women With Breast Cancer: A Step by Step Approach

BackgroundThis study describes the approach and phases of psychotherapeutic interventions in women with breast cancer on the basis of a personality cluster analysis performed using the Structural Analysis of Social Behavior (SASB) Model by Lorna S. Benjamin.MethodsThe SASB Model is a tool for diagnosing and planning the stages of psychotherapeutic intervention. Therefore, based on the cluster analysis of the intrapsychic problems of the 2 different profiles SASB-Love and Autonomy and SASB-Control and Hate Traits, it was possible to describe the phases and methods of the psychotherapeutic SASB intervention for each profile and the most suitable therapeutic approaches.ResultsThe results of the analysis, based on the intrapsychic profile derived from the SASB model and distributed along a continuum, indicate the need for specific psychotherapeutic interventions. Although some common intrapsychic issues were identified, their intensity varied across individuals, suggesting that tailored therapeutic approaches are necessary for each patient. The identified intrapsychic profiles, characterized by passive adaptation, low self-affirmation, and self-criticism, highlight the importance of facilitating self-contact, enhancing self-awareness, and promoting the elaboration and integration of emotional experiences.ConclusionIn this context, a targeted psychotherapeutic treatment aimed at fostering self-affirmation and reducing self-criticism can help women with breast cancer to transform their approach to dealing with their condition, leading to more effective adaptation and improved quality of life.

The effect of psychological resilience and spiritual well-being on the experience of hope in parents of children with cancer

PURPOSE

Hope in pediatric oncology guides parents as an inner guidance compass through their child's challenging journey toward cancer treatment. This study was designed to examine the effects of psychological resilience, spiritual well-being, and some child- and parent-related factors on parents' experience of hope while their child is undergoing cancer treatment.

DESIGN AND METHODS

This cross-sectional, correlational study was conducted between March and July 2022 in the pediatric oncology-hematology ward of a university hospital in Turkey. Parents of 120 children with cancer were included in the study. Data were collected using the child and parent questionnaire, Herth Hope Index, Connor-Davidson Resilience Short Form, and Spiritual Well-Being Scale. Correlation and multiple linear regression analysis were used to analyze the data. In addition, the content analysis method was used to analyze the open-ended structured questions. Ethical approval was obtained for the study.

RESULTS

In the study, 57.5% of the parents who participated were mothers. The mean age of the children was 9.46 ± 5.00 years. 30.8% of the children were diagnosed with Acute Lymphoblastic Leukemia, and the mean duration of treatment was 20.42 ± 13.75 months. According to multiple linear regression analysis, child gender (β = -0.16), number of children (β = -0.16), cancer diagnosis (β = -0.24), resilience (β =0.31), and parental spiritual well-being (β =0.40) were the determinant factors affecting parents' experiences of hope. All these predictors explained 55% of the change in parents' hope levels. In addition, two main themes (increasing and decreasing factors) were identified regarding parents' experiences of hope.

CONCLUSIONS

Insights from this study have the potential to shape interventions specifically designed to maintain parents' hope throughout their child's cancer treatment journey.

IMPLICATIONS FOR PRACTICE

This study may provide insights for the design of intervention programs in pediatric oncology hematology wards aimed at strengthening the hope and improving coping mechanisms of parents with children coping with cancer.

The impact of spiritual care on the psychological health and quality of life of adults with heart failure: a systematic review of randomized trials

Background

Heart failure (HF) brings not only physical pain but also psychological distress. This systematic review investigated the influence of spiritual care on the psychological well-being and quality of life in adults with HF.

Methods

We conducted a systematic literature review following PRISMA guidelines, searching seven electronic databases for relevant randomized controlled studies without language or temporal restrictions. The studies were assessed for quality using the Cochrane Bias Risk tool.

Results

A total of 13 studies (882 participants) were reviewed, investigating interventions such as religion, meditation, mental health, cognitive interventions, and spiritual support. Key factors influencing the effectiveness of spiritual care implementation included integration into routine care, respect for diversity, patient engagement, intervention quality, and alignment with patient beliefs. The majority of the studies indicated that spiritual care has a potentially beneficial impact on the mental health and quality of life of patients with HF.

Conclusion

The findings provide valuable insights for healthcare professionals, highlighting the importance of adopting a spiritual care approach to healthcare for this population.

Effects of Nursing Care Provided to the Relatives of Palliative Care Patients on Caregivers' Spiritual Well-Being and Hope: A Randomized Controlled Trial

The aim of this study is to determine the effects of nursing care, based on Watson's Theory of Human Caring, given to the relatives of palliative care patients on caregivers' spiritual well-being and hope. This research was planned as a randomized controlled trial and conducted among 60 patient relatives (intervention group: 30, control group: 30) taking care of their patients in five palliative care units in Turkey. Data were collected via the Introductory Information Form on Patient Relatives, the Beck Hopelessness Scale, and the Spiritual Well-Being Scale. Although administered nursing care caused a significant difference in the Beck Hopelessness Scale scores of the intervention group (U= 235.5, p = 0.001); no change was measured in scores from the Spiritual Well-Being Scale (U=385.0, p = 0.336). The findings of the study evidenced that nursing care based on Theory of Human Caring diminished the hopelessness levels of patient relatives while causing no effect on their spiritual well-being.

Psychometric Properties of the Turkish Version of the Nurse Spiritual Therapeutic Scale for Oncology Patients and Caregivers

This study evaluated the Turkish version of the Nurse Spiritual Therapeutic Scale for assessing oncology patients' and caregivers' needs. It involved 200 participants from July 2022 to May 2023. The scale demonstrated high validity (content validity index = 0.97) and good internal consistency (Cronbach's alpha = 0.879). Factor analysis revealed a 20-item single-factor structure with satisfactory representation (factor loadings: 0.29-0.89). Item-total score correlations indicated moderate to strong relationships (0.236-0.761). The model showed a good fit (goodness-of-fit indices > 0.90). The Turkish version of the scale is valid and reliable for assessing oncology patients' and caregivers' spiritual care needs.

Vitality Revisited: The Evolving Concept of Flourishing and Its Relevance to Personal and Public Health

Human flourishing, the state of optimal functioning and well-being across all aspects of an individual's life, has been a topic of philosophical and theological discussion for centuries. In the mid-20th century, social psychologists and health scientists began exploring the concept of flourishing in the context of health and high-level wellness. However, it is only in recent years, in part due to the USD 43 million Global Flourishing Study including 22 countries, that flourishing has entered the mainstream discourse. Here, we explore this history and the rapid acceleration of research into human flourishing, defined as "the relative attainment of a state in which all aspects of a person's life are good" by the Harvard University's Flourishing Program. We also explore the construct of "vitality", which refers to a sense of aliveness, energy, and motivation; we contend that this has been neglected in the flourishing movement. We explore why incorporating measures of vitality, together with a broader biopsychosocial approach, considers all dimensions of the environment across time (the total exposome), which will greatly advance research, policies, and actions to achieve human flourishing.

Perceived burden of dementia care, clinical, psychological and demographic characteristics of patients and primary caregivers in Iran

Caregiving for dependent older adults with dementia has become an important public health issue. However, not much is known about the caregiver experience for caregivers of patients with dementia in Iran. This study was designed to examine the relationship between variables pertaining to primary caregivers and patients and the level of perceived caregiver burden. The participants of this cross-sectional study were 60 caregiver and care-recipient pairs presented to Rasoul-e Akram hospital and Brain and Cognition Clinic, in Tehran, Iran. A sociodemographic questionnaire, the Zarit Caregiver Burden Interview (ZBI), the General health questionnaire-28 (GHQ-28), the NEO Five-Factor Inventory (NEO-FFI), the Spiritual Well-Being Scale (SWBS), the Neuropsychiatric Inventory (NPI), and the Mini-Mental State Examination (MMSE) were used. Descriptive statistics, correlation coefficients, T-test, and multiple linear regression analyses were used in this study. Years of caregiving, hours of caregiving/week, total and subscale GHQ-28 scores, existential well-being subscale score on SWBS, and total NPI score were found to be significantly associated with the level of caregiving burden (p < 0.05). In addition, among the caregivers' personality traits, neuroticism and agreeableness predicted caregiver burden. Other sociodemographic factors and MMSE scores were not found to be significantly related to caregiver burden. A better understanding of the indicators of caregiver burden can help physicians, policy makers, and mental health managers to tailor the most appropriate preventative and remedial interventions for family caregivers.

Anxiety, depression and quality of life: a longitudinal study involving cancer patient-caregiver dyads

BACKGROUND

The objective of this study was to analyse the relationships between anxiety, depression and quality of life in cancer patient-caregiver dyads during the first 6 months after the diagnosis using the actor-partner interdependence model (APIM).

PARTICIPANTS AND PROCEDURE

Sixty-seven cancer patient-caregiver dyads completed the following questionnaires in a prospective longitudinal design, with two assessment points at a 6month interval, T1 (45-60) and T2 (180-200 days after diagnosis): the Hospital Anxiety and Depression Scale (HADS) and the Short Form Health Survey Questionnaire (SF-36). Descriptive statistics, t-test and bivariate correlations were applied. The APIM was used to analyse the influence of anxiety and depression (T1) on own (actor effect) and partner (partner effect) quality of life in T2.

RESULTS

The results did not reveal any differences between T1 and T2 in anxiety and depression in caregivers and patients. Assessing the differences between T1 and T2 with respect to quality of life, the caregiver results showed an improvement in physical functioning and bodily pain, but lower social functioning and mental health scores. For patients, significantly lower scores were observed in general health and vitality scores. Dyadic analysis showed an actor effect of anxiety and depression on most of the quality of life domains and a partner effect in caregiver depression (T1) and general health in patients (T2).

CONCLUSIONS

The early assessment of anxiety and depression may help to prevent declines in quality of life in the first few months following a diagnosis of cancer in patient-caregiver dyads.

The effect of anxiety and spiritual well-being on the care burden of caregivers of cancer patients during the COVID-19 pandemic

Objectives

The COVID-19 pandemic has adversely affected the caregivers of people with all chronic diseases, including people with cancer (PWC). This study was conducted to determine the impact of anxiety and spiritual well-being on the care burden of caregivers of PWC during the COVID-19 pandemic.

Design

This cross-sectional descriptive study included 250 caregivers of hematology and oncology patients registered with a cancer support association. All participants completed the following self-report questionnaires: the Spiritual Well-Being Scale (SWBS), Generalized Anxiety Disorder 7-item scale (GAD-7), and the Zarit Caregiver Burden Interview (ZBI).

Results

Most (82.4%) of the caregivers expressed fear that their patient may contract COVID-19, and 42.0% stated that they had difficulty getting to the hospital. The caregivers’ mean ZBI score was 21.06 ± 14.64, their mean GAD-7 score was 14.51 ± 6.02, and their mean SWBS score was 111.50 ± 16.84. According to the results of regression analysis, SWBS and GAD-7 scores had a significant effect on the ZBI score (p < 0.05).

Conclusion

In this study, anxiety explained most of the care burden during COVID-19. Therefore, during the COVID-19 pandemic, it may be beneficial to implement practices to promote spirituality and reduce anxiety in caregivers of PWC.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06611-0.

Spiritual quality of life in family carers of patients with advanced cancer-a cross-sectional study

Purpose

Caring affects carers’ psychological and physical health, mortality, and quality of life (QoL) negatively. Lower spiritual QoL is associated with anxiety and depression, but the spiritual dimension is rarely investigated in carers. The present study aimed to explore which patient- and carer-related characteristics were associated with spiritual QoL in carers of patients with advanced cancer.

Methods

Secondary analyses were conducted using data from a prospective study investigating integration between oncology and palliative care. Adult patients with advanced cancer and their carers were included, and baseline data considering demographics, clinical characteristics, symptoms, social support, and religious meaning-making were registered. Spiritual QoL was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual well-being (FACIT-Sp-12) questionnaire. Associations to spiritual QoL were explored by bivariate and multivariate regression models.

Results

In total, 84 carers were included, median age was 62.5 years, 52 (62%) were female, and the average spiritual QoL score was 23.3. In bivariate analyses, higher education, social support, and lower patients’ symptom burden were significantly associated with higher spiritual QoL. The multivariate regression model (n=77) had an explained variance (R²) = 0.34 and showed a significant association for social support, higher education, having children < 18 years living at home, and patient’s age.

Conclusion

The study indicates that spiritual QoL in carers were low and were negatively affected by several factors related to both carers and patients. However, there could be other important factors not yet described. Health care professionals should be aware of the known associated factors, as carers who hold these may need extra support.

Spirituality among family caregivers of cancer patients: The Spiritual Perspective Scale

Spirituality is a critical resource for family caregivers of patients with cancer. However, studies on spirituality are hampered because measures of spirituality lack consistency and have not been validated in cancer caregivers. This study examined the validity of the Spiritual Perspective Scale (SPS) among cancer caregivers and explored whether measurement bias may influence differences in spirituality across caregiver and patient characteristics. In this secondary analysis, 124 caregivers of cancer patients were used to evaluate the validity of the 10-item SPS. A multiple indicators multiple causes model was applied to explore differences in the association between a latent spirituality factor and characteristics of caregivers and patients. Overall reliability of the SPS was adequate (Cronbach's α = .95). The SPS scores were predictive of higher meaning and purpose (r = .32, p = .004) and lower depression (r = -.22, p = .046) at 3-month follow-up. Construct validity of the SPS with a single-factor structure was supported in cancer caregivers. Adjusting for a direct effect of race did not alter the pattern of results, and caregivers who were older, female, ethnic minorities, less-educated, affiliated with a religion, and who provided care to another individual in addition to the patient had greater levels of spirituality. This study provides evidence for psychometric validation of the SPS in cancer caregivers. Understanding differences in caregivers' spirituality by using the SPS with psychometrically acceptable properties and minimal measurement bias deserves more attention to optimize spirituality assessment and support in cancer caregiving.

Spirituality alleviates the burden on family members caring for patients receiving palliative care exclusively

Background

Spirituality can give meaning to life, providing support and guidance in complex situations. Despite its importance in palliative care, the role of spirituality for family caregivers of patients under exclusive palliative care has not received enough attention in the literature. We aimed to address the correlation between spirituality and the emotional burden of family members of patients under exclusive palliative care.

Methods

This transversal study was conducted in a tertiary private teaching hospital, in São Paulo, Brazil. The study comprised family members of patients receiving palliative care exclusively. Only one caregiver who cared for the patient for at least 2 months was invited to participate. Family members answered the following questionnaires: WHOQOL spirituality, religiousness and personal beliefs (SRPB), Zarit Burden Interview (ZBI) and Self-Reporting Questionnaire (SRQ-20). They were excluded if patients were residing in a Long Stay Institution. Continuous variables were expressed by median and quartiles and analyzed with the Kruskal-Wallis test with Muller-Dunn post-test adjusted by Bonferroni or with the Mann-Whitney test for two groups. We used multivariable linear regression to identify independent predictors of caregiver burden.

Results

A total of 178 family members were interviewed in a median of 8 [4–13.25] days after patient admission. Almost 40% of families presented high score of burden. Faith and Meaning in Life were the facets that scored the highest, with a median of 4.50 [4.00–5.00] for both facets. There was an inverse correlation between Zarit score and all of the WHOQOL-SRPB facets, indicating that the lower the spirituality, the greater the emotional burden. Inner peace was the strongest protective factor associated with burden.

Conclusions

Psycho-socio-spiritual interaction can improve the coping ability of family caregivers of patients under exclusive palliative care, addressing a critical gap in the provision of holistic palliative care services.

Current Advances in Palliative & Hospice Care: Problems and Needs of Relatives and Family Caregivers During Palliative and Hospice Care-An Overview of Current Literature

Palliative and hospice care aims to improve quality of life of patients’ relatives, but still little is known about their specific problems and needs. We present a comprehensive literature update. Narrative review to present an expert overview of peer-reviewed, English-written original research publications and reviews on psychosocial and existential problems, supportive needs as well as interventions for relatives during the patients’ disease trajectory published between January 2017 and November 2018. A total of 64 publications were included. Relatives report high rates of psychological and existential distress, burden and psychological morbidity during the total disease trajectory of the patient. In addition, relatives report an alarmingly high number of unmet needs with information being the central issue. Relatives’ problems and needs are part of complex systems influenced by various socio-demographic factors and patient–relatives-interactions and dependency between different psychological phenomena. First support interventions for relatives during disease trajectory have proven feasible and secondary data from randomized studies suggest beneficial effects of providing early palliative care also for relatives. Relatives should be addressed to a still larger extent in the daily practice of palliative and hospice care, thus further research to reveal more detailed systematic information is needed to improve relatives’ psychological burden and quality of life.