Spiritual well-being and psychological resilience in outpatients receiving chemotherapy: The multiple mediating role of symptoms

Purpose This study aimed to investigate the relationship between symptom status, spiritual well-being, and psychological resilience in patients with cancer. Methods This study employed a quantitative, cross-sectional, and correlational design. The study sample consisted of 240 cancer patients who presented to the oncology day treatment unit of a university hospital in Türkiye. Data were collected using the Sociodemographic Information Form, Edmonton Symptom Assessment Scale, Spiritual Well-Being Scale, and Connor-Davidson Resilience Scale-Short Form. Stepwise multiple regression, and structural equation modeling were used to analyze the data. Results The mean age was 58.93 ± 11.21 years, and the sample was nearly equally distributed by gender. In the stepwise multiple regression analysis, spiritual well-being was the strongest positive predictor of resilience (β = 0.601, p < 0.001). General well-being impairment, anxiety, fatigue, and pain were significant negative predictors (R² = 0.728, p < 0.001). Parallel mediation analysis revealed that spiritual well-being has a significant impact on resilience through multiple mediators. It had an adverse indirect effect via pain and positive indirect effects via fatigue, anxiety, and general well-being. The overall indirect effect of spiritual well-being on resilience was significant (β = 0.159, 95 % CI [0.139, 0.262], p < 0.05), accounting for 21.01 % of the total effect, indicating partial mediation. Conclusion These effects were not only statistically significant but also clinically meaningful, indicating the importance of interventions to enhance spiritual well-being in improving resilience. The findings demonstrated that spiritual well-being not only has a direct positive effect on resilience but also exerts indirect effects through key physical and psychological symptoms, including pain, fatigue, anxiety, and impaired general well-being.