Abstract
Purpose
Maintenance of quality of life (QOL) is vital for adaptation to life-threatening and chronic illnesses such as cancer. Therefore, the evaluation and strengthening of personal psychological resources that support QOL for patients with cancer is paramount. This study investigated the potential mediating role of hope in the relationship between spiritual well-being and QOL in Iranian cancer patients.
Methods
A correlational predictive design was used with 200 patients with varying types and stage of cancer. Demographic and health characteristic surveys, spiritual well-being (SWB), adult hope, and EORTC QLQ-c30 scales were used for measuring the study constructs. Path analysis modeling was used to determine mediation relationships.
Results
Patients’ QOL was affected by SWB and hope. Religious (β = 0.205, p = 0.002) and existential (β = 0.286, p < 0.001) SWB dimensions and hope (β = 0.263, p < 0.001) improved QOL scores. The presence of hope partially mediated the relationship between SWB and QOL.
Conclusion
Quality of life was directly affected by SWB and was further improved by the presence of hope. The study suggests that maintenance of hope is essential to QOL in Iranian patients with cancer.
Similar content being viewed by others
Availability of data and materials
The current study datasets and analysis sheets are available and will be provided due to reasonable request.
Code availability
Not applicable.
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424
Shrestha A, Martin C, Burton M, Walters S, Collins K, Wyld L (2019) Quality of life versus length of life considerations in cancer patients: a systematic literature review. Psycho-oncology. 28(7):1367–1380
Linden W, Vodermaier A, MacKenzie R, Greig D (2012) Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord 141(2-3):343–351
Niedzwiedz CL, Knifton L, Robb KA, Katikireddi SV, Smith DJ (2019) Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer 19(1):1–8
Molina Y, Jean CY, Martinez-Gutierrez J, Reding KW, Joyce P, Rosenberg AR (2014) Resilience among patients across the cancer continuum: diverse perspectives. Clin J Oncol Nurs 18(1):93–101
Pahlevan Sharif S, Lehto RH, Sharif Nia H, Goudarzian AH, Haghdoost AA, Yaghoobzadeh A, Tahmasbi B, Nazari R (2018) Religious coping and death depression in Iranian patients with cancer: relationships to disease stage. Supportive Care in Cancer 26(8):2571–2579
Zamanian H, Eftekhar-Ardebili H, Eftekhar-Ardebili M, Shojaeizadeh D, Nedjat S, Taheri-Kharameh Z, Daryaafzoon M (2015) Religious coping and quality of life in women with breast cancer. Asian Pac J Cancer Prev 16(17):7721–7725
de la Torre-Luque A, Gambara H, López E, Cruzado JA (2016) Psychological treatments to improve quality of life in cancer contexts: a meta-analysis. Int J Clin Health Psychol 16(2):211–219
Teo I, Krishnan A, Lee GL (2019) Psychosocial interventions for advanced cancer patients: a systematic review. Psycho-oncology. 28(7):1394–1407
Ferrell BR, Dow KH (1997) Quality of Life among Long-Term Cancer Survivors. Oncology 11(4):565–571
Sibeoni J, Picard C, Orri M, Labey M, Bousquet G, Verneuil L, Revah-Levy A (2018) Patients’ quality of life during active cancer treatment: a qualitative study. BMC Cancer 18(1):951
Chopra I, Kamal KM (2012) A systematic review of quality of life instruments in long-term breast cancer survivors. Health Qual Life Outcomes 10(1):14
Peteet JR, Balboni MJ (2013) Spirituality and religion in oncology. CA Cancer J Clin 63(4):280–289
Afrooz R, Rahmani A, Zamanzadeh V, Abdullahzadeh F, Azadi A, Faghany S, Pirzadeh A (2014) The nature of hope among Iranian cancer patients. Asian Pac J Cancer Prev 15(21):9307–9312
Al-Natour A, Al Momani SM, Qandil AM (2017) The relationship between spirituality and quality of life of Jordanian women diagnosed with breast cancer. J Relig Health 56(6):2096–2108
Hann D, Baker F, Denniston M, Gesme D, Reding D, Flynn T, Kennedy J, Kieltyka RL (2002) The influence of social support on depressive symptoms in cancer patients: age and gender differences. J Psychosom Res 52(5):279–283
Li M-Y, Yang Y-L, Liu L, Wang L (2016) Effects of social support, hope and resilience on quality of life among Chinese bladder cancer patients: a cross-sectional study. Health Qual Life Outcomes 14(1):73
Canada AL, Murphy PE, Fitchett G, Stein K (2016) Re-examining the contributions of faith, meaning, and peace to quality of life: a report from the American Cancer Society’s Studies of Cancer Survivors-II (SCS-II). Ann Behav Med 50(1):79–86
Tabrizi FM, Radfar M, Taei Z (2016) Effects of supportive-expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors: a randomized control trial. Psycho-Oncology. 25(9):1057–1063
Flanigan M, Wyatt G, Lehto R (2019) Spiritual perspectives on pain in advanced breast cancer: a scoping review. Pain Manag Nurs 20(5):432–443
Rohani C, Abedi H-A, Omranipour R, Langius-Eklöf A (2015) Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: a prospective study with comparative design. Health Qual Life Outcomes 13(1):40
Lehto RH (2012) The challenge of existential issues in acute care: nursing considerations for the patient with a new diagnosis of lung cancer. Clin J Oncol Nurs 16(1):E4–E11
Ng GC, Mohamed S, Sulaiman AH, Zainal NZ (2017) Anxiety and depression in cancer patients: the association with religiosity and religious coping. J Relig Health 56(2):575–590
Chirico F (2016) Spiritual well-being in the 21st century: it’s time to review the current WHO’s health definition. J Health Soc Sci 1(1):11–16
Rassool GH (2000) The crescent and Islam: healing, nursing and the spiritual dimension. Some considerations towards an understanding of the Islamic perspectives on caring. J Adv Nurs 32(6):1476–1484
Rustøen T, Cooper BA, Miaskowski C (2010) The importance of hope as a mediator of psychological distress and life satisfaction in a community sample of cancer patients. Cancer Nurs 33(4):258–267
Ahaddour C, Van den Branden S, Broeckaert B (2018) Between quality of life and hope. Attitudes and beliefs of Muslim women toward withholding and withdrawing life-sustaining treatments. Med Health Care Philos 21(3):347–361
Ellison CW (1983) Spiritual well-being: conceptualization and measurement. J Psychol Theol 11(4):330–338
Pahlevan Sharif S, Lehto R, Amiri M, Ahadzadeh A, Sharif Nia H, Haghdoost AA, Khoshnavay Fomani F, Goudarian AH (2021) Spirituality and quality of life in women with breast cancer: The role of hope and educational attainment. Palliative and Supportive Care 19(1):55–61
Musarezaie A, Ghasemi TMG, Esfahani HN (2012) Investigation the quality of life and its relation with clinical and demographic characteristics in women with breast cancer under chemotherapy. Int J Prev Med 3(12):853–859
Westland JC (2010) Lower bounds on sample size in structural equation modeling. Electron Commer Res Appl 9(6):476–487
Soper DS (2015) A-priori sample size calculator for structural equation models [software]. Version 4.0. Available from http://www.danielsoper.com/statcalc
Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST, Yoshinobu L, Gibb J, Langelle C, Harney P (1991) The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol 60(4):570–585
Ebadi P, Bahari F, Mirzaei HR (2013) The effectiveness of reality therapy on the hope of breast cancer patients. Iranian Quarterly Journal of Breast Disease 6(2):26–34
Yailagh MS, Ghahfarokhi FK, Maktabi GH, Neasi A, Samavi A (2012) Reliability and validity of the hope scale in the Iranian students. J Life Sci Biomed 2(4):125–128
Paloutzian RF, Ellison CW (1982) Loneliness, Spiritual Well-Being and the Quality of Life. In: Peplau LA, Perlman D (eds) Loneliness: A Sourcebook of Current Theory, Research and Therapy. John Wiley & Sons, New York, pp 224–237
Sharif Nia H, Sharif SP, Boyle C, Yaghoobzadeh A, Tahmasbi B, Rassool GH et al (2018) The factor structure of the spiritual well-being scale in veterans experienced chemical weapon exposure. J Relig Health 57(2):596–608
Fayers P, Aaronson NK, Bjordal K, Sullivan M (1995) EORTC QLQ–C30 Scoring Manual. European Organisation for Research and Treatment of Cancer, Brussels
Fayers P, Aaronson NK, Bjordal K, Curran D, Gronvold M (1999) EORTC QLQ–C30 Scoring Manual, 2nd edn. European Organisation for Research and Treatment of Cancer, Brussels
Baron RM, Kenny DA (1986) The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51(6):1173–1182
Alpar R (2011) Applied multivariate statistical methods. Detay, Ankara, pp 10–29
Jo KH, Son BK (2004) The relationship of uncertainty, hope and quality of life in patients with breast cancer. J Korean Acad Nurs 34(7):1184–1193
Burt N (2011) Hope and spirituality and their relationship to the overall quality of life in cancer patients. Dissertation, Indiana State University, Terre Haute, Indiana
Fitch MI, Bartlett R (2019) Patient perspectives about spirituality and spiritual care. Asia Pac J Oncol Nurs 6(2):111–121
Asgeirsdottir G, Sigurdardottir V, Gunnarsdottir S, Sigurbjörnsson E, Traustadottir R, Kelly E et al (2017) Spiritual well-being and quality of life among Icelanders receiving palliative care: data from Icelandic pilot-testing of a provisional measure of spiritual well-being from the European Organisation for Research and Treatment of Cancer. Eur J Cancer Care 26(2):e12394
Walker SJ, Chen Y, Paik K, Mirly B, Thomas CR, Hung AY (2017) The relationships between spiritual well-being, quality of life, and psychological factors before radiotherapy for prostate cancer. J Relig Health 56(5):1846–1855
Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A (2013) Spiritual well-being and quality of life in Iranian women with breast cancer undergoing radiation therapy. Support Care Cancer 21(5):1219–1225
Author information
Authors and Affiliations
Contributions
Mobin Mohammadinezhad: data collection, manuscript writing.
Naiemeh Seyedfatemi: study supervision, study design contributions, data analysis, and manuscript writing.
Hamid Sharif Nia: statistical analysis and interpretation, manuscript writing.
Rebecca H. Lehto: manuscript writing including revisions.
The authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval
Ethical Committee of Iran University of Medical Sciences approved the study (approval number: IR.IUMS.REC.1398.140).
Consent to participate
All the participants signed the written consent forms. All the participations were assured regarding their privacy in this study and informed about volunteer entering in the study and willingness to exclude from the study at any time.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sharif Nia, H., Lehto, R.H., Seyedfatemi, N. et al. A path analysis model of spiritual well-being and quality of life in Iranian cancer patients: a mediating role of hope. Support Care Cancer 29, 6013–6019 (2021). https://doi.org/10.1007/s00520-021-06172-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-021-06172-2