Spiritual, psychosocial, and physical correlates of well-being across the breast cancer experience

Abstract

Spirituality has gained increasing attention by scientists for its importance in contributing to understanding human health experiences. The purpose of this study was to examine the relationships of spiritual, psychosocial, and physical correlates to well-being and depression over the trajectory of breast cancer experience. Nursing theory, lifespan development, and chronic illness trajectory provided the conceptual framework for the study. A correlational, retrospective design was used allowing for collection of longitudinal data during a one-time measurement process. The sample consisted of 64 women (constituting a 91% response rate) 60 years or older with Stage I, II, or III breast cancer, who had chemotherapy and/or radiation, and were 8 to 24 months post treatment. A set of questionnaires was used to obtain data over three phases of their breast cancer experience: Anticipatory; Therapy; and Survivor. For data analysis, it was determined that all instruments had adequate reliability and validity, and statistical assumptions were met. Multiple regression results indicated that two variables in particular (self-transcendence and symptom distress) were consistently significant in explaining well-being and depression (with explained variance ranging from 57% to 85%) across all three phases. Other variables (hope, spiritual perspective, social support) also contributed significantly to the explained variance across some phases. Repeated Measure ANOVA and post hoc tests indicated that the scores on several variables differed significantly depending upon the phase of illness. While symptom distress is often a primary concern of patient and nurse, it was concluded that spiritual variables are also important factors in experiences of well-being and depression across the trajectory of the illness. A second conclusion was that, as with physical or social aspects, spirituality includes many dimensions of human experience and should be studied for the variety of spiritual factors that may be significant across the trajectory of illness. In this study, at least one or more different spiritual variables were significant in the regression equations for every phase of illness. Findings provided empirical evidence to refine and further develop a mid-range theory on how spirituality functions as an important resource for well-being within the context of other variables, across the breast cancer experience.