Spiritual Status and Quality of Life in Hospice Family Caregivers: A Cross-Sectional Study

Context: Family caregivers (FCs) of terminally ill cancer patients face substantial strain that can impair quality of life (QoL). However, how spiritual status affects QoL, and whether these relationships differ by religious affiliation, remains unclear. Objectives: This study examines the association between spiritual status and QoL among FCs of terminally ill cancer patients Methods: A cross-sectional survey was conducted at nine hospice care units in South Korea (n = 170 FCs). Spiritual status was addressed using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being questionnaire (FACIT-Sp-12) and three self-rated questions that addressed spirituality, religiosity, and spiritual pain. QoL was measured using the Korean version of the Caregiver Quality of Life Index-Cancer (CQOLC-K) questionnaire. Multivariate regression analysis, adjusted for covariates via stepwise selection, was used to examine the associations between spiritual variables and CQOLC-K total and each subscale. Results: In adjusted analyses, Positive Adaptation was the only CQOLC-K subscale associated with all spiritual measures, including Meaning/peace, Faith of FACIT-Sp-12, self-rated spirituality, religiosity, and spiritual pain. No consistent independent association was observed with the CQOLC-K total. In stratified models, these associations were confined to caregivers with a religious affiliation. Spiritual pain showed subgroup-specific patterns: among religious caregivers it coexisted with higher positive adaptation and greater burden, while among non-religious caregivers it was related to worse financial concerns. Conclusion: In this cohort, spirituality aligned with domain-specific adaptation, and this linkage was limited to caregivers with a religious affiliation. Brief screening for spiritual pain and religious affiliation may help tailor meaning-focused or practical support accordingly.