The Effects of Symptom Distress and Depression on Quality of Life in Patients With Terminal Cancer: The Mediating Role of Meaning in Life and Spiritual Well-being.

Background: Terminal cancer patients experience worsening physical symptoms, psychological challenges, and spiritual difficulties. Improving the quality of life (QOL) and reconstructing the meaning of life (MIL) for these patients ensure a dignified end-of-life experience. Spiritual well-being is necessary to promote effective end-of-life coping strategies.

Objective: This study aimed to construct and verify the suitability of a model that explains the impact of physical and psychological factors on the QOL of patients with terminal cancer using MIL and spiritual well-being as mediating factors.

Methods: The participants were patients with terminal cancer 25 years or older hospitalized in 40 nationally designated hospices. A total of 172 patients were included in the final analysis. Data analysis was performed using structural equation modeling.

Results: In the effect analysis of the final model, the variables affecting QOL were depression (β = -.62, P < .001), symptom distress (β = -.33, P = .001), and spiritual well-being (β = .36, P = .002), and a significant indirect effect of MIL was found in the depression-MIL-spiritual well-being and depression-MIL-QOL paths.

Conclusions: Spiritual interventions that help people find their MIL can serve as an important component of optimal hospice and palliative care for patients with terminal cancer.

Implications for practice: In clinical practice, interventions that increase the MIL and spiritual well-being of patients with terminal cancer are needed. Additionally, the practice will see other benefits including enhanced patient care, psychological support, effective treatment planning, family caregiver support, and further research advancement.