title: The impact of patient quality of life and spirituality upon caregiver depression for those with advanced cancer.
abstract: OBJECTIVE
  Little is known about relationships between patient spiritual well-being and caregiver outcomes for those with advanced cancer. We were interested in examining the relationship between patient physical quality of life (QOL) and caregiver depression and to also evaluate whether patient spiritual well-being (SWB) played a mediating role in this relationship.
  
  
  METHODS
  This is a prospective longitudinal study that was conducted in the outpatient clinics at a university-affiliated comprehensive cancer center. 226 patients with Stage III or IV cancer (lung, GI, GYN) and their primary caregivers were interviewed upon enrollment into the study and three months later. Measures of spirituality, health-related quality of life, and physical functioning were included in the interviews.
  
  
  RESULTS
  Key findings were that the relationship between patient physical QOL and caregiver depression was inverse and moderate (β = -0.24, p = 0.004) and that patient SWB (meaning/peace) played a significant (p = 0.02) and medium-size role (β = -0.31) in mediating the relationship between patient physical QOL and caregiver depression. The nature of these relationships was stable over time.
  
  
  CONCLUSIONS
  Patients' spirituality is central to their coping and adjusting to cancer. It is this aspect of patient overall quality of life that mediates the relationship to caregiver well-being. The most potent intervention for caregiver depression may be attending to patient spiritual distress.
authors.affiliation: Case Western Reserve University, Cleveland, Ohio.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Douglas
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Daly
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing / Q000523:psychology*; D010166:Palliative Care / Q000379:methods / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D029181:Spirituality