Association between Perceived Social Support and Existential Well-Being in Patients with Advanced Cancer: An Examination of the Contribution of Confidant and Affective Support to Sense of Meaning and Peace

Abstract

Background: Existential well-being (EWB) and its components, meaning and peace, have been shown to reliably predict quality of life (QOL) and distress in patients with cancer. Few studies have examined EWB as an outcome in and of itself, which has created a gap in our understanding of the factors that predict this important domain of QOL. Even less research has explored the unique predictors of meaning and peace separately. Extant studies suggest that there may be important distinctions with regards to how meaning and peace relate to social context factors, including social support and social well-being. The aim of the current study was to examine whether two types of perceived emotional support -- the perception that one is loved and cared for and the availability of a confidant -- would demonstrate unique associations with meaning and peace, and whether these associations would be moderated by depressive symptoms.;Methods: The current study performed secondary analyses on existing baseline data from 122 patients with advanced cancer (65% female, 84% Caucasian) who participated in a randomized controlled trial of Individual Meaning-Centered Psychotherapy. Participants completed the FACIT-Meaning/Peace, DUKE-UNC-Functional Social Support Questionnaire, and HADS-Depression.;Results: Affective support was a unique predictor of Meaning, B = 1.27, 95% CIs [0.20, 2.23], p = .019, above and beyond depression, confidant support, and Peace, explaining 3.9% of unique variance. Confidant support was a unique predictor of Peace only when depression was not included in the final model, B = 0.924, 95% CIs [0.02, 1.80], p = .044, and explained 2.6% of the total variance in Peace. A marginal interaction effect was found between affective support and depression in predicting Meaning, B = 0.24, 95% CIs [-0.00, 0.48], p = .054. Depression also significantly moderated the effect of confidant support on Peace, B = - 0.05, 95% CIs [-0.08, -0.01],p = .005. Post-hoc analyses revealed that affective support was positively associated with Meaning only in patients with HADS-D scores > 7. Confidant support had a positive effect on Peace in patients with HADS-D scores < 4.4.;Conclusions. The current study found evidence for the important role of perceived affective support for sense of meaning in patients with advanced cancer, especially for those with clinically significant symptoms of depression. Findings also highlighted the potentially complex association between confidant support and sense of peace as a function of depression. Clinical applications include targeting perceptions of love and affection as a strategy for enhancing or preserving sense of meaning and purpose in patients who present with depressive symptoms.