Li-Ting Huang

Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department


Major Professor

Susan C. McMillan, Ph.D., ARNP

Committee Member

Cindy S. Tofthagen, Ph.D., ARNP

Committee Member

Cathy D. Meade, Ph.D., RN

Committee Member

Brent J. Small, Ph.D.


Palliative Care, Dyads, Spirituality, Structural Equation Modeling, LISREL


The World Health Organization and the leading hospice organizations have emphasized the inclusion of family caregivers of hospice patients with cancer into end-of-life care, as these two dyad members may spiritually and emotionally influence each other. Given that depression and spiritual needs, which are prominent in these pairs, may impair quality of life (QOL) of hospice dyads, examining mutuality within dyads is imperative to develop a more accurate model that includes family caregivers. Therefore, the purpose of the study was to elucidate the importance of mutual effects within hospice dyads by examining the contribution of depression and unmet spiritual needs on their personal and their counterparts’ QOL. Structural equation modeling was used to integrate the feature of actor and partner effects in the Actor-Partner Interdependence Model. After eliminating outliers, the final sample was comprised of 660 hospice dyads in which the majority of hospice patients were white (97%) and male (56.6%) with a mean age of 73 years. Most of the family caregivers were white (95.9%) and female (73.5%) with a mean age of 65 years. On average, hospice patients reported a depression score of 4.00 (SD = 1.53), and their family caregivers had a significantly lower mean depression score of 3.65 (SD = 1.48). With respect to their spiritual needs, 25.5% of hospice patients indicated going to religious services was an unmet need, and about 13% of family caregivers also reported that going to religious services was an unmet spiritual need, followed by being with friends, laughing, thinking happy thoughts, and being around children. The results of structural equation modeling revealed that depression and spiritual needs in cancer patients and family caregivers exhibited significant actor effects on the individual’s QOL after controlling for the partner effects. Among the spousal pairs, depression in family caregivers exhibited a positive partner effect on hospice patients’ functional well-being (β = .15, p < .05), implying that as depressive symptoms increase, hospice patients’ functional well-being increases. This study supported the need for considering both as one unit and the mutuality inherent in dyads. The findings of the study suggest the importance of consistent assessment in emotional and spiritual well-being for hospice patients as well as family caregivers, as their concerns may be transmitted to each other due to mutuality existing within the dyads.

Included in

Nursing Commons