Abstract
Caregivers of cancer patients find it challenging to perform their roles and to meet the demands of caregiving. Spirituality has been investigated as a potential coping strategy employed by caregivers, yet spirituality and related practices vary among cultural groups. In this study, we investigated the relationship between spirituality and health-related quality of life (HRQOL) and evaluated mediation effects of loneliness on this relationship. The sample was 234 lower socioeconomic status (SES) Hispanic caregivers of breast cancer survivors using existing data from the Support for Latinas with Breast Cancer and Their Intimate and Family Partners study, funded by the American Cancer Society (Badger, PI). A cross-sectional analysis was conducted at baseline, using self-reported spirituality, loneliness, and HRQOL data collected from 2012 to 2017. The exposures and outcomes were assessed using the Spiritual Well-Being Scale, the Social Isolation—Short Form 8a PROMIS Item Bank v2.0 scale, and the Global Health Scale PROMIS v.1.0/1.1 scale. Descriptive and mediation analyses using the Preacher and Hayes’ approach were conducted to estimate the direct effect of spirituality on HRQOL and the indirect effect of spirituality through mediation of loneliness in relation to HRQOL. A positive association between spirituality and HRQOL was found, whereas loneliness was inversely associated with HRQOL (b = − .18, SE = .03, p < .0001). Age did not function as a moderator of the spirituality-HRQOL association in any of the models tested, but in the model testing mediation, loneliness was shown to mediate the association between spirituality and HRQOL (b = − .17, p < .0001). These results suggest that spirituality may be beneficial to HRQOL in caregivers of Hispanic breast cancer survivors, due in part to reduced loneliness among more spiritual caregivers.
Highlights
Caregiving has numerous adverse consequences related to the informal caregiver’s health, with caregivers reporting increased physical and psychological symptoms following cancer diagnosis [1]
As self-reported loneliness decreased and spirituality increased, health-related quality of life (HRQOL) improved. These findings showed that caregiver loneliness played a significant role as a mediator in the relationship between caregiver Spiritual Well Being (SWB) and HRQOL, which is the first demonstration of this effect among Hispanic cancer caregivers reported in the literature
While survivors were not the focus of this study, our finding suggested that the nature of the relationships between SWB, loneliness, and HRQOL among Hispanic cancer caregivers were similar to other studies where these are significant relationships to consider for dyadic outcomes [39, 42]
Summary
Caregiving has numerous adverse consequences related to the informal caregiver’s health, with caregivers reporting increased physical and psychological symptoms following cancer diagnosis [1]. Caregiving is burdensome; 40% of caregivers defined as family members or friends who provide unpaid supportive, informational, and emotional care [2] report high burden and 18% report medium burden [3]. 72% of caregivers of cancer patients spend an average of 33 h weekly with patients, and caregiving may involve complex medical care [3]. Caregivers report equal, if not higher, levels of emotional distress relative to the cancer survivors [6]. Caregivers regularly support cancer survivors emotionally while providing complex medical and personal care in the home, but each caregiver’s unique level of distress can
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