Background: A diagnosis of Cancer often leads patients to experience a breakdown in spirituality that could undermine his/hers life. Spirituality troubles seem to be related with emotional problems – triggered by physical and practical difficulties – that lead to experience psychological distress. However, there aren’t definitive results on these relationships. This study aimed to test a multiple step mediation moderated analysis in which spirituality moderates the process that leads to distress. Methods: Patients (N = 200, 54.6% female, mean age = 64.3, SD = 12.3) were consecutively enrolled at “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy – Department of Medical Oncology. Patients were tested with NCCN’s Distress Thermometer and Problem List (DT&PL; NCCN, 2003) assessing: (A) distress and (B) physical (α = .77), (C) practical (α = .68), (D) social (α = .70), (E) emotional (α = .85) and (F) spirituality problems. Results: First, a CFA was performed to test the factorial structure of the PL. The factor structure was confirmed: RMSEA = .064; CFI = .904. Then, a multiple step mediation moderated analysis (5000 bootstrap resampling) shows model’s significance [F = 59.9; p < .001; R2 = .49; Eff.Size = .364]. Surprisingly, in absence of spiritualty problems, the relationship between physical problems and distress was partially mediated (path c’: β = .118, p = .016) by practical problems (path a1: β = .061, p = .001) by relationships problems (path d1: β = .281, p < .001) and by emotional problems (path d2: β = .612, p = .013; and path b3: β = .889, p < .001). Opposite, in presence of spiritualty problems, none of these relationships reached statistical significance (p > .05) – showing effects of interaction on each of these paths. Conclusions: These surprising results highlight the role of spirituality. The process from physical difficulties to psychological distress follows a specific path only in absence of spirituality issues. These findings suggest new ways in which psycho-oncologists should structure interventions to improve quality of life and reduce psychological suffering paying attention to the spirituality sphere of the oncological patient.
When the loss of spirituality leads to the loss of the path: The moderating role of spirituality in a multiple-step-mediation process from physical suffering to distress
Rossi, A
Conceptualization
;Mannarini, S;
2018
Abstract
Background: A diagnosis of Cancer often leads patients to experience a breakdown in spirituality that could undermine his/hers life. Spirituality troubles seem to be related with emotional problems – triggered by physical and practical difficulties – that lead to experience psychological distress. However, there aren’t definitive results on these relationships. This study aimed to test a multiple step mediation moderated analysis in which spirituality moderates the process that leads to distress. Methods: Patients (N = 200, 54.6% female, mean age = 64.3, SD = 12.3) were consecutively enrolled at “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy – Department of Medical Oncology. Patients were tested with NCCN’s Distress Thermometer and Problem List (DT&PL; NCCN, 2003) assessing: (A) distress and (B) physical (α = .77), (C) practical (α = .68), (D) social (α = .70), (E) emotional (α = .85) and (F) spirituality problems. Results: First, a CFA was performed to test the factorial structure of the PL. The factor structure was confirmed: RMSEA = .064; CFI = .904. Then, a multiple step mediation moderated analysis (5000 bootstrap resampling) shows model’s significance [F = 59.9; p < .001; R2 = .49; Eff.Size = .364]. Surprisingly, in absence of spiritualty problems, the relationship between physical problems and distress was partially mediated (path c’: β = .118, p = .016) by practical problems (path a1: β = .061, p = .001) by relationships problems (path d1: β = .281, p < .001) and by emotional problems (path d2: β = .612, p = .013; and path b3: β = .889, p < .001). Opposite, in presence of spiritualty problems, none of these relationships reached statistical significance (p > .05) – showing effects of interaction on each of these paths. Conclusions: These surprising results highlight the role of spirituality. The process from physical difficulties to psychological distress follows a specific path only in absence of spirituality issues. These findings suggest new ways in which psycho-oncologists should structure interventions to improve quality of life and reduce psychological suffering paying attention to the spirituality sphere of the oncological patient.
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