Exploring the relationship between loneliness, spirituality, and health-related quality of life in Hispanic cancer caregivers

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.

Keywords: Cancer; Caregiver; Hispanic; Loneliness; Spirituality.

Fig. 1

Mediation: general health, spiritual well-being, and loneliness. Note. Figure values are unstandardized regression coefficients. Coefficient in () is the indirect effect. * p < .05. *** p < .001

Fig. 2

Moderated mediation: indirect effect of spirituality on perceived health varies as a function of age, where age is moderating the path from spirituality to loneliness. Note. Figure values are unstandardized regression coefficients. Coefficient in () is the indirect effect. * p < .05. *** p < .001

Fig. 3

Moderated mediation: indirect effect of spirituality on health varies as a function of age, where age is moderating the path from loneliness to perceived health. Note. Figure values are unstandardized regression coefficients. Coefficient in () is the indirect effect. * p < .05. *** p < .001