Spiritual well-being and quality of life in maintenance hemodialysis patients: a latent profile analysis and serial mediation model

Background: From a positive psychology perspective, this study aimed to identify the latent profiles of spiritual well-being and analyze the serial mediation mechanism of family care and spiritual coping in the relationship between spiritual well-being and health-related quality of life (HRQoL). The findings are intended to inform strategies for improving the spiritual well-being of maintenance hemodialysis (MHD) patients. Methods: A cross-sectional design was employed with 220 MHD patients recruited from two tertiary hospitals in Guangdong, China (August 2023-January 2024). Assessments were conducted using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-SP-12), Family Care Index, Spiritual Coping Questionnaire (SCQ), and Short Form-12 Health Survey (SF-12). Latent profile analysis (LPA) was employed to identify heterogeneous subgroups based on spiritual well-being. A chain mediation model was then used to examine the mediating effects of family care and spiritual coping. Results: < 0.001). LPA identified four distinct profiles: Low spiritual well-being (36.8%), Moderate spiritual well-being (20.0%), Peaceful Mindset with Low Spiritual Belief (13.6%), and High spiritual well-being (29.5%). The mediation analysis revealed that family care and spiritual coping partially mediated the relationship between spiritual well-being and HRQoL (effect sizes: 0.074-0.175, 95% CI excluding 0). The chain mediation pathway "spiritual well-being → family care → spiritual coping → HRQoL" was statistically significant, with total indirect effects of 0.268 and 0.114 (95% CIs excluding 0). Conclusion: Spiritual well-being indirectly influences the quality of life in MHD patients through the serial mediation of family care and spiritual coping. Clinicians should recognize the heterogeneity in spiritual well-being and integrate routine spiritual screening into nursing assessments to identify patients with low spiritual well-being. It is recommended to develop family-based education and support programs, along with interventions that combine family care and spiritual coping strategies, so as to improve patients' long-term health outcomes.