Associations between Spirituality, Mindfulness, and Psychological Symptoms among Advanced Lung Cancer Patients and Their Spousal Caregivers

Context:
Metastatic lung cancer (LC) patients and their spousal caregivers are at high risk of psychological symptoms. Mindfulness may improve psychological symptoms via spiritual well-being (SW); yet, this mediation model has not been examined in a dyadic context.

Objectives:
We examined the mediating role of two dimensions of SW (meaning/peace, faith) in the mindfulness-symptoms link in stage IV LC patients and their spousal caregivers.

Methods:
We examined the actor-partner interdependence model of mediation (APIMeM) using multivariate multilevel modeling with 78 couples. Four APIMeM analyses were conducted to examine: 1 predictor (mindfulness) × 2 mediators (meaning/peace, faith) × 2 psychological symptoms (depressive symptoms, cancer distress). We also tested four alternative models in which mindfulness mediates the associations between SW and psychological symptoms.

Results:
The alternative model (SW→ Mindfulness→ Psychological symptoms) was preferred than the original model (Mindfulness→ SW→ Psychological Symptoms). For patients, meaning/peace was directly associated with their own psychological symptoms, while faith was only indirectly associated with their own psychological symptoms via mindfulness. For spouses, meaning/peace was both directly and indirectly associated with their own psychological symptoms, while faith was only directly associated with their own depressive symptoms (but not cancer distress). Moreover, spouses' faith was indirectly associated with patients' psychological symptoms through patients' mindfulness.

Conclusions:
SW are associated with patients and spouses' psychological symptoms both directly and indirectly through mindfulness. Thus, interventions that target SW, particularly meaning and peace, along with mindfulness may be beneficial to the psychological management of patients facing a terminal disease and their spousal caregivers.

Keywords: caregiver; dyads; mediation; metastatic lung cancer; mindfulness; psychological symptoms; spiritual well-being.

PMID: 33039605 DOI: 10.1016/j.jpainsymman.2020.10.001